Membership Form

    First Name (required):

    Surname (required):

    Your Address (required):

    Town (required):

    County (required):

    Post Code (required):

    Your Email (required):

    Mobile Number (required):

    Boat name (required):

    C Q Berth No (required):

    Boat Make & Model (required):

    Vessel Type (required):

    Engines (required):

    Fuel Type (required):

    Length in metres (required):

    Beam in metres (required):

    Vessel Category (required):

    Any other information:

    By submitting this form you agree to CQBHA using your details and email address in relation to Association matters. These details are never divulged or shared with any other third parties.

    I Agree (required):

    BEFORE YOU SEND, Please check that all details above are correct.