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Membership Application
Date__________________
Name_________________________________________________
Phone #’s:
HM (____)_____________ WK (____)______________ Mobile(____)______________
Street Address______________________________________________________________
City_____________________________ ST_____________ Zip ______________
EMAIL Address________________________________________________________
Driver’s License___________________________________ Date of Birth__________
Emergency Contact _________________________________________________________
Name Phone Relation
Please list existing Marine/sailing/boating organization or club membership(s):
Please list any formal training you have had in boating, sailing, or flying, such as Coast Guard Auxiliary, Power Squadron, Red Cross, Private Instruction, Civil Air Patrol, Commercial Pilots License, Merchant Marine Captain, Mate, Deck Hand, etc.
Please List types of previously sailed vessels/boats and years of sailing experience:
Signature X____________________________
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