JOG Application for Membership

Please print and complete this form and send it with cheque or complete standing order mandate to: Peter Chartres, Secretary, 28 Nodes Road, Cowes, Isle of Wight PO31 8AB

I hereby apply for membership of JOG in the class shown below.
Surname:..........................................	Forename and Initial:.......................................... (Known as): ..........................................
Address: .......................................... Postcode:..........................................	Occupation:.......................................... Tel No (Home):.......................................... Tel No (Office):.......................................... email:
Sailing experience: ..............................................................................................................................
Name of yacht currently owned (if any):.......................................... Sail number:.......................................... Type:..........................................
Signed:..........................................	Date:..........................................
I enclose a cheque as follows: (delete as appropriate) In respect of this years subscription OR I have completed the Standing Order Mandate (below) in respect of this years and future years subscriptions.
(Tick appropriate option) Racing Member £25 [_] Crew/Ordinary Member £15 [_]	Family Racing Member £37 [_] Family Member (Crew/Ordinary) £22 [_]
Note: Members joining on or after 1st October of any year become members until 31st December of the following year.
Statement by Proposer and Seconder
I confirm from my personal knowledge that the above applicant will be a suitable member of JOG
Signed:..........................................	(BLOCK CAPS)..........................................
I believe that the above applicant will be a suitable member of JOG
Signed:..........................................	(BLOCK CAPS)..........................................

Standing Order Mandate

Standing order mandate for JOG membership fees. Please print and complete this form and send it with your completed order for if you would like to set up a Standing Order to cover your membership fees for this and subsequent years.

Bank:..........................................
Full branch address: ..........................................
Please pay	Lloyds Bank, Newport Isle of Wight Branch	Sorting Code: .......................................... (Official use only)
for the credit of	Junior Offshore Group	Account Number:.......................................... (Official use only)
the sum of (delete as appropriate)	£15.00 (Fifteen Pounds Only) - Ordinary Member £22.00 (Twenty Two Pounds Only) - Ordinary Family Member £25.00 (Twenty Five Pounds Only) - Racing Member £37.00 (Thirty Seven Pounds Only) - Racing Family Member
With immediate effect and then on the 2 January annually, until further notice, quoting reference

Account Name to be Debited:..........................................	Date:..........................................
Account Number:..........................................	Signature:..........................................