Please complete this form, print it, sign it, and mail it to
Secretary, BOA NSW P.O. Box 212, Spit Junction NSW 2088 or fax it to (02) 9960 1859
Surname
Title (Mr/Ms/Mrs/Miss/Dr etc)
Occupation (Optional)
Street Address
Postal Address (if different)
Suburb / State / Postcode
Phone number
Mobile Number
Fax number
E-mail Address
New Subscription
Additional Contribution
First Year Membership $30*
Payment Method
Card Type
Bankcard Mastercard Visa
Card Number
Expiry Date (month/year)
Boat Name
Vessel Registration No. (Waterways)
Length
Type
Trailer Moored Sail Power
Location of mooring (eg, name of bay)
Mooring Number (if applicable)
Signed
Date