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Marine Rescue Cockburn - New member
Please complete this form so that we have accurate records in the event we need to contact/assist you.
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YOUR DETAILS
Woodman number
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Your answer
First name
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Your answer
Surname
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Your answer
Street address
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Your answer
Suburb
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Postcode
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Your answer
Home phone
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Mobile phone
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Email address
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I'm a member of....
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Cockburn Power Boats Association
Port Coogee pen holder
Not a member of a boating club
Other:
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