Kimberley Member Application Form | Kimberley Coast Cruising Yacht Club

Kimberley Members

Please enter your details below. The items marked with * are required to be completed.

User Name*

Your User Name must be unique. Try your boats name, first name, or your nickname, but if another Member already has that User Name, you will have to change it when you submit the form.
Password*
Enter Password Confirm Password

Type a password you will use to Log In to the KCCYC website.
Email*
Enter Email Confirm Email

Please Note. If you have used this email address for another membership application (EG husband or wife), you cannot use if for another membership. Or, if you already submitted this form, but not proceeded with the PayPal payment, you cannot use this email address again. Either use another email address, or contact us on the Contacts Page and we will delete your previous record, which will allow you to use the same email address in a new membership form.
Name*
First Last
Postal Address*
Street Address City State / Province / Region ZIP / Postal Code Country

Your Membership Pack will be posted to this address.
Phone
Website/Blog

If you have your own website or blog, we can link it to your member profile.
Vessel Name

Only fill in the Vessel Name if you are the owner or co-owner of the vessel. If you are a crew member, or are a temporary land lubber, leave this blank. It can be edited at a later date in your member profile page.
Photo*
Accepted file types: jpg, gif, pdf, , Max. file size: 2 MB.
Photo*
Accepted file types: jpg, gif, pdf, Max. file size: 2 MB.
Upload up to 3 photos from your computer as proof of your Kimberley cruising on a private vessel. File types accepted are - jpg, gif, pdf. Maximum file size per photo 2MB.
Polo Shirt Size*
Please select one shirt size.
Shipping*
- Australia
- International
Delivery within Australia is by Australia Post Express. Delivery Overseas is by standard Airmail
Total
$ 0.00
Upon clicking the Submit button you will be redirected to the PayPal website for secure payment. Upon clicking the Submit button you agree that you have read and understand the KCCYC Privacy Policy and Disclaimer. https://kccyc.org.au/privacy-policy-and-disclaimer/