As you are renewing via a link in our email, we have pre-filled in the information we had on record.

Please double check and change any information that may be out of date.

This form will require payment when submitted via PayPal. The PayPal system also works without a PayPal account (just enter your card details). Alternatively, if you prefer to pay in person or by bank transfer you can use our downloadable application form.

The VMR Jacobs Well Associate Membership is $77 per year (Age Concessions $66 per year). Your membership must be active for 72 hours prior to your breakdown assistance entitlements commencing.

VMR Jacobs Well Associate Membership covers you for breakdown assistance for all areas south of the northern tip (Potts Point) of Macleay Island to the North Arm of the Coomera River, including the Logan, Albert, Pimpama Rivers and Jumpinpin Bar. Our extended coverage includes areas north to Bribie Island and south to Southport and Point Danger under the Terms and Conditions of our VMR Southern Zone Extended Service Agreement.

Offshore (ie: offshore from North & South Stradbroke and Moreton Islands) assistance is available at the discretion of the Resource Controller and under the advisement of the Gold Coast Water Police. Offshore assistance may incur a cost. Free Inshore coverage consists of towing (breakdowns or fuel), soft groundings and jump starts. In the event of a tow being required, we will tow you back to your point of departure that day or the nearest safe harbour; whichever the Duty Skipper deems appropriate on the day. Harbour to harbour tows for maintenance or repairs are not covered and are classed as a commercial job. Please contact the base to discuss the job.

Search and Rescue, Qld Ambulance First Response Activations, Police Activations and Medical Evacuations are our primary role. Activations for people or vessels in genuine distress will not be charged, members or non-members.

VMR Jacobs Well offers a radio listening watch 24/7 365 days a year. Active weekend crews are on site at the base from 1800 hours Friday until 1800 hours Sunday each weekend and public holidays. Midweek crews operate from 0600 hours to 1800 hours Monday to Friday. After hours a delay may occur in responding.

This form will ask you for rego details your vessel, car and trailer (if applicable). As well as some additional information of you vessel such as colour and motor make/type. We use this information to assist if finding you when you require our assistance.

Where you see the asterisks (*) this field is required, and we need you to provide the information to complete the form.

We send electronic renewal notices to help us keep costs down.

On a rare occasion a newsletter/community announcement, you can also keep informed by liking our Facebook page.

Are you purchasing a NEW or RENEWING your membership?

If your details have not changed, you do not need to fill in information other than your Name, Email, Phone and DoB so we can match your records.

Please provide your details here.

Street address, P.O. box, company name, c/o

City

State / Province / Region

Postal / Zip Code

We require a mobile number (ideally yours) so we can reach you when you are on the water (it must start with 04).

If you do not have a house number, you can add your next of kin. If you cannot reach you on the mobile, this is the next number we try.

To receive the concession rate you must be 65 years (on the day of joining) or older and hold a valid Pension Card or Seniors Card. Sorry other concessions are not valid for a discount.

You must provide your Pension Card or Seniors Card Number. We will manually validate your eligibility for the concession when processed. If you are not eligible you will be required to pay the difference for your membership to be active.

Please provide as much information about your vessel here so we have an accurate idea of what you have should we need to look for you.

Does your vessel have a name? If not, leave me blank

If your vessel is measured in feet (ft), 3ft is equal to 1m. So if your vessel is 15feet, that would be 5m. A JetSki is approximately 3.5m long.

This is a number... On an outboard this would be the big sticker, for example 60, 115, 175. JetSkis and Inboard motors would be a bit trickier to find.

Does your vessel have any radios fitted?

If your VHF Radio is fitted with DSC, you can provide your AMSA-issued MMSI. This is not required for the VHF radio to function.

Please provide the car/trailer information here so we know what you may have driven in/parked near the boat ramp

If your vessel goes on a trailer, providing us with the rego helps us look for you in the carparks should you be overdue.

If your vessel has a mooring providing us with the location helps us look for you should you be overdue.

Anything else that you want to tell us (if needed)?

Reminder, the annual fee for membership is $77.00 per year. If you hold a valid concession card it is $66.00 per year. Please check the value shown below before paying, the price is based on your answer to the Age Concession question on the second step.

AUD $
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