[Derwent Sailing Squadron] Casual Berthing Indemnity Form

Please complete and return to the office. All information will remain confidential.

Section 1 - Boat Details

Boat Name:

Sail/Rego Number:

Lenght (metres): *

Beam (metres): *

Draught (metres): *

Arrival Date: *

Departure Date: *

Please upload evidence of current Public Liability Insurance file(s)

Click Here to Upload

Insuance Company Name: *

Policy Number: *

Expiry Date: *

Section 2 - Contact Details

Mobile Number: *

Email: *

Member of: (if not a member of a yacht club enter NONE) *

Member Number: (if not a member of a yacht club enter 0) *

Section 3 - Access Card

The issued access card is the sole responsibility of the above visitor.
The issued access card will not be subject for loan to a third party.
A $20 per card refundable deposit will be paid for the issue of an access card.
A $20 per card refund will be paid on return of a redundant access card.
A $20 per card administration fee will be paid for any lost or stolen access cards to cover re-stocking and re-programming expenses.
Marina gates will not be caused to remain open as a consequence of any other mechanisms than that provided as part of the system.

The issued access card will not be altered in any way (no holes to be punched into card).

Section 4 - Fees

The following will be used to settle marina fees and any other charges occured during your stay.

Please provide credit card details:

Name on Card: *

Type of Card: *

Card Number: *

Expiry Date: *

CCV Number: *

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Section 5 - Terms and Conditions

I have read and agree to adhere to the casual berthing terms and conditions set out by the Squadron which can be found at https://dssinc.org.au/wp-content/uploads/2022/12/Terms-and-Conditions-of-Casual-Berthing-2022.pdf

Once submited please allow up to 2 working days for a reply which will confirm available, berth number and pricing.

Our office hours are Monday to Friday 9am to 4.30pm.