Application For Membership Please complete these details to create your PCC website account and make your application to become a member.I hereby apply for membership of the Portishead Cruising Club. I declare that I am in sympathy with the objectives of the club and, if elected, agree to abide by its rules. Name First Name Last Name SubscriptionDiscounted - £40 / 1 YearJunior membership is for one child under 18. Student membership is for one 18-25 year old in full time education. Other discounted membership available at the discretion of the committee.Family - £130 / 1 YearFamily membership is for any group of 2 adults (18 and over) + 2 juniors (under 18)Single - £95 / 1 YearOne adult membership for age 18 and over. Automatically renew subscriptionDiscount Code: Applying discount code. Please wait... Other Family Members Names of family members - other than the main contact name above. Reason for Discount Please state the reason that you are applying for discounted membership.Contact Info E-mail* Phone/Mobile Mobile number preferred so we can contact you during club activities.Account Username* Usernames must be unique, so it is best to make a username from your last name and initials or first name, or all three. Password* Repeat Password* Boat Information Boat Name Please give the name of the boat that you own, or regularly sail on as crew. Leave this blank if you have yet to find a boat. Your Role OwnerCrewNot Chosen Please choose the role you fulfil on the boat. Make and Model Sail Number Please give your sail number so that we can identify your boat in races or other club activities.PrivacyPortishead Cruising Club (PCC) stores your personal information for the purposes of administering your membership of the sailing club and club activities as detailed on this website. PCC never shares this data. For full details of our privacy policy; please follow Privacy the link in the footer. I give permission for the website to collect and store the data I am submitting on this form.* Application Approved? *WaitingYesEmail PreferencesCheck the club activities that interest you; and we will keep you up-to-date by email.Select a Payment MethodManual / OfflineCredit / Debit CardNo payment methods are available for the selected subscription plan.Payment DetailsBilling DetailsBilling First Name*Billing Last Name*Billing Email*Billing CompanyIf entered, this will appear on the invoice, replacing the First and Last Name.Billing Address*Billing City*Billing Post CodeBilling Country*AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDemocratic Republic of the CongoDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoNorth MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the CongoReunionRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweBilling State / ProvinceProcessing. 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