Membership Checkout Membership Level change You have selected the Family membership level. Two adults maximum, and children up to 18 years The price for membership is $120.00 per Year. Make a Gift $ Account Information Already have an account? Log in here Username Password Confirm Password Email Address Confirm Email Address Full Name LEAVE THIS BLANK Member Information Membership Name Phone Number for text messages KBC may occasionally send important alerts and club text messages to your mobile phone Club Activities you are interested in Fishing Sailing Diving Social Power Boating Family Members Add your family members here Adult Member 1 Adult Member 2 Child Member 1 Child 1 Age Group Under 5 5-10 10-14 15-18 Child Member 2 Child 2 Age Group Under 5 5-10 10-14 15-18 Child Member 3 Child 3 Age Group Under 5 5-10 10-14 15-18 Child Member 4 Child 4 Age Group Under 5 5-10 10-14 15-18 Child Member 5 Child 5 Age Group Under 5 5-10 10-14 15-18 Child Member 6 Child 6 Age Group Under 5 5-10 10-14 15-18 Boat Information This information is held and may be important in an emergency. Do you own a boat Yes No Boat Name Boat Type Sail Number Class or make Length Power Unit Hull Colour Cabin Colour Distinctive Markings Equipment VHF Radio CB Radio Flares Lifejackets EPIRB Nav Lights Spotlight GPS Radar Radio Call Sign Trailer Registration (Number plate number) Boat Image Add an image of your Boat Emergency Contacts Contact Name 1 Contact Phone 1 Contact Name 2 Contact Phone 2 Declaration I declare I wish to be a member of the Kapiti Boating Club Has your membership of any other Boating/Chartered club ever been declined suspended or revoked or been the subject of disciplinary proceedings? Yes No Name of Club and details Have you ever been convicted of any crime under the crimes act? Yes No Please advise date and details Would you like to set up automatic renewals? Yes, renew at $120.00 per Year. Billing Address First Name Last Name Address 1 Address 2 City State Postal Code Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands US Armed Forces Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Phone Payment Information We accept all major credit cards Card Number Expiration Date CVC Join our mailing list. Kapiti Boating Club Processing...
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