Rowing Tasma nia Inc. ABN: 21 731 822 046 P.O. Box 912 Launce ston Tas. 7250 www .rowin g t as ma n ia . c o m .a u

Membership Application/Registration Subscription Form Season 2016/201

(Membership period7 1 October 2016 to 30 September 2017)

Please complete all sections in block letters. Enter ‘n/a’ (not applicable) where relevant. Title Given Names Last Name Mailing Address Suburb Postcode Phone Fax Mobile Email (please print clearly) Date of Birth Occupation Name of Club Name of School/Association Preferred Volunteer Roles (1) (2) (3) (Boat driver, maintenance, committee, adviser etc.) ALL APPLICANTS WHO DID NOT REGISTER WITH ROWING TASMANIA INC. IN THE 2014/2015 SEASON AND WHO ARE INTENDING TO COMPETE IN ANY CATEGORY OTHER THAN SENIOR OR REC/VET, MUST ATTACH A COPY OF THEIR BIRTH CERTIFICATE.

I AM (circle applicable option) APPLYING FOR / RENEWING / UPDATING MY REGISTRATION/MEMBERSHIP AS FOLLOWS: (Please place an ‘X’ in all boxes applicable to your proposed participation and pay highest relevant subscription amount)  $85 Pennant/Regatta Competitor  $30 School Rower (Insurance Only. Non-Pennant Competitor)  $30 Coxswain  $30 Master (Non-Pennant Competitor)  $30 Official  $30 Coach  $30 Social Rower (Insurance Only. Non-Pennant Competitor)  $Nil Life Member (Form for contact information only)  $Nil Other (club members not covered by above categories, volunteers)

Conditions and Notes: 1. All registrations include GST. 2. Where a Club/School/Association is specified, application to be lodged and subscription paid via your nominated organization. 3. Membership/Registration includes compulsory and automatic insurance cover under the Rowing Australia National Insurance Program. Please refer to Rowing Australia website for details of cover, terms and conditions http://www.vinsurancegroup.com/rowing If membership/registration is not renewed by 30 September each year, any insurance cover lapses on 1 October following for the period until registration is received by Rowing Tasmania Inc. 4. This application, when lodged with Rowing Tasmania Inc., must be accompanied by the highest prescribed subscription (and a copy of the applicant’s birth certificate, if applicable) for the proposed participation level detailed above. 5. Registration is subject to the Constitution and By-Laws of Rowing Tasmania Inc. and is not valid until subscription monies have been received by Rowing Tasmania Inc. NO CURRENT MEMBERSHIP  NO ROW 6. All coaches are required to be registered for his/her crew to row. NO REGISTRATION  CREW DOES NOT ROW 7. Rowers, coxswains, coaches, clubs and schools may be deemed ineligible for pennant points, trophies, medals and awards where participants are not registered at the time of rowing. 8. An Applicant electing to change the nominated participation during the season must lodge a supplementary application and pay any additional subscription prior to participating at the new level. 9. An Applicant, upon signing, agrees to be subject to, and shall abide by, all relevant provisions issued from time to time and contained in the Constitution, Rules, By-Laws, Policies, Code of Conduct and Racing Code of Rowing Tasmania, including the Anti-Doping Policy. 10. Applicants are advised that all personal information, including photographic images, are managed under the Rowing Tasmania Privacy Policy. 11. Applicants may be subject to additional regatta, facility and services fees/levies, as applicable. I declare that the above information is true and correct and agree to be bound by the conditions above and all relevant provisions issued from time to time as contained in the Constitution, Rules, By-Laws, Policies, Code of Conduct and Racing Code of Rowing Tasmania, including the Anti-Doping Policy. Signature of Applicant Date

Signature of Guardian Date (applicant under 18 years) En d or sem e nt b y S ec ret a r y / Club C a pt a i n /S c h o o l / A ss o c i a ti o n Coord i n a tor On behalf of the Club/School/Association detailed above, I declare that to the best of my understanding the above information is true and correct and agree to take all reasonable steps to ensure that the Applicant complies with the conditions above and all relevant provisions issued from time to time as contained in the Constitution, Rules, By-Laws, Policies, Code of Conduct and Racing Code of Rowing Tasmania, including the Anti-Doping Policy. Signature of Club/School/ Date Position Assoc. Representative