P.S.D.

PORT STEPHENS DISTRICT

BODYBOARDERS

PORT STEPHENS DISTRICT BODYBOARDERS

Contact Information:
President Drew Sheedy 0408 247 080
Vice President Daniel Ankeney 0402 525 322

Treasurer - Tracy Brewer 0411 493 208

Secretary Jules Collins 0418 355 212
Media/Marketing Lachlan Bylhouwer 0466 535 215
Club related events Drew Sheedy 0408 247 090
Feel free to contact any of us with any issues/ideas/ messages that may arise.

2014 Membership Application

Applicants Personal Details

SURNAME:_____________________CHRISTIAN NAME/S:_______________________
DATE OF BIRTH:____________________________ AGE:___________
ADDRESS:_______________________________________ POSTCODE:__________
PHONE NUMBER:_____________________ MOBILE:_______________________
EMAIL ADDRESS:_________________________________________________________
FATHERS NAME:__________________ MOTHERS NAME:_______________________
CAN YOUR PARENTS HELP OUT: YES / N0

PSDB Divisions in 2014 are:

Groms (U14),

Cadets (U16),

Juniors (U18),

Open

Masters

Please circle your division

Competitors under 18 years MUST have application signed by a parent or guardian.

All competitors must have swimming ability and knowledge of surf safety.
All fees must be paid in full before applicant can be permitted to compete.

Registration Fee covers: All monthly comps, 12 months insurance, Incorporation fee,
Surfing Australia affiliation and a Club T-Shirt - size (circle) XS / S / M / L / XL

Full years fee: $80 - Payable as cheque or money order to:

PSDB (PORT STEPHENS DISTRICT BODYBOARDERS) (or in cash on registration day)

MEDICAL INFORMATION FORM

APPLICANTS NAME:_______________________________________________________
ADDRESS:_______________________________________ POSTCODE:_____________
EMERGENCY CONTACT PHONE NUMBER(S):___________________________________
DOCTORS NAME:________________________________________________________
PHONE NUMBER:_______________

MEDICAL CONDITION (circle)

FURTHER INFORMATION
(medication/treatment/special instructions)

Epilepsy... yes / no :____________________________________

Fainting / Dizzy Spells...yes / no :____________________________________
Heart Condition.....yes / no :____________________________________
Diabetes....yes / no :____________________________________
Ear Disorder..... yes / no :____________________________________
Asthma..... yes / no :____________________________________
Allergies (inc insect bites). yes / no :____________________________________
Other Conditions...yes / no: ____________________________________
_____________________________________________________________________
I hereby give my permission for the Officials of PSDB to seek any medical
service that I/my son/my daughter may require in the event of any accident or
medical emergency.

APPLICANTS NAME: (please print) ___________________________________

APPLICANTS SIGNATURE: _________________________ DATE: ____________
PARENT / GUARDIANS NAME: (for under 18 yrs): ________________________
PARENT / GUARDIANS SIGNATURE: __________________ DATE:____________

Disclaimer
In consideration of my acceptance as a member of PSDB I intend to be legally
bound and do hereby for myself, my heirs and administrators, waive, release
and forever discharge all rights to claims for damages which may hereafter
accrue against the PSDB, its Officials, employees, agents and sponsors of any
liability or responsibility arising from and injury received or incurred by
participating in PSDB events. I further acknowledge that I voluntarily assume all
risks arising from conditions related to the use of the contest site and surfing
area by myself and others. I will comply with any and all rules announced at
the events or attached to the event notice board. I also give permission for my
child to be photographed for the purposes of promotion and record keeping by
the clubs sanctioned photographers.

APPLICANTS NAME (please print) ____________________________________

APPLICANTS SIGNATURE: ____________________________ DATE: _________
PARENT / GUARDIANS NAME: (for under 18 yrs): ________________________
PARENT / GUARDIANS SIGNATURE: ____________________ DATE: _________