Application Form for 2022 In the event of a Form Submission error, please email treasurer@killaloesailingclub.com To apply to join the club as a new member, or renew an existing membership, please complete the form below: Membership Type* Current Member Renewal New Member Application Lead Member Name* First Last Address* Street Address Address Line 2 City County Eircode AfghanistanAlbaniaAlgeriaAmerican 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 RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussiaRwandaRéunionSaint 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 IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Contact Number*Email* Membership Category* Single (Must be age 18 or over) Family Family Membership Details (Adults)*First NameLast Name Add RemoveList names of adult family members, apart from Lead MemberFamily Membership Details (Juniors)*First NameLast NameDate of Birth Add RemoveList names & dates of birth of all junior family membersDo You Own a Boat?* No Yes Boat Details*Type of BoatBoat Sticker No. (Admin only)Sail Number Add RemoveAdd details of all boatsBoat Insurance Details*InsurerPolicy No.Expiry Date (dd/mm/yyyy) Add RemoveBoat Insurance Confirmation* I, the undersigned, declare that any boat owned or provided by me while parked or involved in any sailing activities at Killaloe Sailing Club Ltd has all appropriate insurance cover including, but not limited to, racing risk insurance cover, public liability and Third Party Indemnity of not less than €3,000,000.Boat Owner's Signature*(Where the boat is owned by persons other than this member, the owners signature is required. Parents signature is required if the owner is a Junior member.)Are you willing to help with safety cover and/or assist with club activities and/or maintenance?* Yes I can help No I can't help currently If you, or any family who are members of KSC, have a medical condition the club should be aware of, please give details below:Indemnity* I, the undersigned, hereby acknowledge and agree that participating in sailing and related activities at Killaloe Sailing Club Ltd has inherent risk, including risk of personal injury or loss of life. I understand these risks and hereby indemnify Killaloe Sailing Club Ltd, The company, its directors, officers, committee and volunteers from any and all liability or loss. I confirm that I have read and understood the club safety statement and standing orders governing the operation of the Club.Member's Signature*(Please discuss any Safety concerns you have with The Club Safety Officer or any committee Members)GDPR Consent* By ticking this box I/We agree to allow KSC to store my/our details. To allow contact for club activities, KSC agree to follow the GDPR guidelines as outlined on the Data Protection page.Membership Fee CalculatorMembership Type* Single Renewal With Development Levy (€160.00) Family Renewal With Development Levy (€240.00) Single New Member With Joining Fee (€220.00) Family New Member With Joining Fee (€275.00) No. of Boats for Parking Fee*Choose0 Boat Parking (€0.00)1 Boat Parking (€60.00)2 Boats Parking (€90.00)3 Boats Parking (€120.00)4 Boats Parking (€150.00)Club Boat Usage Fee (Current Members)* Boat Usage Not Required Yes to Boat Club Usage (€80.00) Club Boat Usage Fee (New Members)* Boat Usage Not Required Yes to Boat Club Usage (€50.00) Voluntary Development Levy (New Single Members)*ChooseNot able to pay levy at presentYes I'd like to contribute levy (€50.00)Voluntary Development Levy (New Family Members)*ChooseNot able to pay levy at presentYes I'd like to contribute levy (€75.00)Total Δ