Ordinary Member (Voting):

[text ordinary-member-name]
[text ordinary-member-surname]
[text ordinary-member-title]
[text ordinary-member-dob]

Family Member (Non-Voting):

[text family-member-name]
[text family-member-surname]
[text family-member-title]
[text family-member-dob]

Please state name and age of children under 18 years old

Children’s names:
[text child1-name]
[text child2-name]
[text child3-name]

Date of Birth:
[text child1-dob]
[text child2-dob]
[text child3-dob]

Country Member (Voting):
[text country-member-voting]

Cadet Member (Non-Voting):
[text cadet-member-nonvoting]

[text work-phone]
[text mobile]

Full Postal Address:
[text postal-address]

E-Mail Address:
[email email-1]
[email email-2]

[text employer]

[text occupation]

Boat Owner: [radio boat-owner use_label_element default:1 “Yes” “No”]
[text boat-owner-name]
[text boat-type]

I am interested in finding out more about the following aquatic activities:
[checkbox aquatic-activities use_label_element “Sailing” “Game fishing” “Water Skiing” “Scuba diving” “Canoeing” “Hobie Sailing”]

We, the undersigned financial members, vouch for the good character and standing of the applicant:
[text nominator-name]
[text nominator-membership]

Select Membership Type:
[select membership-type id:membertype “Single” “Family” “Country” “Cadet” “Family Top-up” “Gymnasium”]

[group single-price]Nomination: K1963.64      Subscription: K809.09      Card Deposit: K50.00      GST: K277.27      Total: K3100.00[/group]

[group family-price]Nomination: K1963.64      Subscription: K1672.72      Card Deposit: K100.00      GST: K363.64      Total: K4100.00[/group]

[group country-price]Available on Application[/group]

[group Cadet-price]Nomination: N/A      Subscription: K95.45      Card Deposit: N/A      GST: K9.55      Total: K105.00[/group]

[group topup-price]Nomination: N/A      Subscription: K636.36      Card Deposit: K50.00      GST: K63.64      Total: K750.00[/group]

[group gym-price]Nomination: N/A      Subscription: K231.82      Card Deposit: N/A      GST: K23.18      Total: K255.00[/group]

[submit “Submit”]