Kimberley Member Application Form 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 AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Your Membership Pack will be posted to this address.PhoneWebsite/Blog If you have your own website or blog, we can link it to your member profile.Vessel NameOnly 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.PhotoPhotoAccepted file types: jpg, gif, pdf.Upload up to 3 photos from your computer as proof of your Kimberley cruising on a private vessel. Alternatively, email the photos to firstname.lastname@example.org File types accepted are - jpg, gif, pdf. Maximum file size per photo 2MB.Polo Shirt Size*Mens SMens MMens LMens XLMens 2XLMens 3XLMens 5XLLadies 8-10Ladies 12-14Ladies 16-18Ladies 20-22Ladies 24-26Please select one shirt size. Shipping*AustraliaInternationalDelivery within Australia is by Australia Post Express. Delivery Overseas is by standard AirmailTotal $ 0.00 Upon clicking the Submit button you will be redirected to the PayPal website for secure payment.