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* ICA Membership Username
* First Name
* Last Name
* Year of Birth
* Address Line 1
* Address Line 2
* Address Line 3
* Email
Home
Business
Mobile
Gender Male Female
Marital Staus Married Unmarried
Occupation
* Health (select) Excellent Very Good Average
* Fitness (select) Excellent Very Good Average
Medication
Medication Reason
Smoker? Yes No
* Availability
* Sailing Experience
* Qualifications
* Sports, Hobbies, Interests
Please indicate whether you wish to be listed for 90 days ($25) or one year ($80).
List me for 90 days $25.00 List me for 1 year $80.00
In clicking the CONTINUE button below, you agree to ICA deducting either $25 or $80 (as selected above) from your account.
* Name on Card
* Card Type Visa Mastercard
* Card Number
* Expiry Date
* Security Number
Finally, please click CONTINUE.
