MEMBERSHIP APPLICATION FORM

ALL FIELDS MARKED WITH * ARE REQUIRED.

PERSONAL INFORMATION:

FULL NAME: *

SPOUSE/SIGNIFICANT OTHER:

HOME ADDRESS: *

CITY: *

STATE: *

ZIP CODE: *

BUSINESS INFORMATION:

BUSINESS NAME: *

BUSINESS ADDRESS: *

OCCUPATION: *

CITY:

STATE:

ZIP CODE: *

ADDITIONIAL INFORMATION:

EMAIL ADDRESS: *

HOW DID YOU HEAR OF US?:

CONTACT INFORMATION:

HOME PHONE: *

CELL PHONE: *

WORK PHONE: *

CORRESPONDENCE TO:

HOME WORK

EMERGENCY CONTACT:

EMERGENCY PHONE:

EMERGENCY CONTACT'S NAME:

BOAT DESCRIPTION:

MAKE:

YEAR:

REG#:

BOAT LENGTH:

(overall length from swim platform to bow)

BEAM:

DRAFT:

BOAT NAME:

POWER BOAT SAILBOAT

TYPE OF MEMBERSHIP APPLYING FOR:

  BOATING (not available)
  STANDBY BOATING (waiting list) --- $500 Init./$999 Dues
  RECREATIONAL & SOCIAL ------------ $225 Init./$595 Dues
  MIDWEEK --------------------------------- $175 Init./$395 Dues
  SOCIAL ----------------------------------- $135 Init./$325 Dues

WAITING LIST:

STANDBY BOATING

BILLING:

Billing is done on a monthly basis.
Please DO NOT mail your initial payment
with your application.

CHILDREN UNDER 21:

NAME: AGE: DOB: NAME: AGE: DOB: NAME: AGE: DOB: NAME: AGE: DOB:

I understand that this membership covers myself, my spouse, and my children under 21.

CREDIT REFERENCES:

BANK NAME, ETC:

SPONSORING MEMBER:

MEMBER NAME:

MEMBER NUMBER:

AUTHORIZED SIGNATURES:

By checking this box you are agreeing to all terms and conditions of this application.

TODAY'S DATE:

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