How long have you been boating and where?

What program topics would interest you?

Are you insured?

Have you taken and completed
 a boating course?  If so where?

Name of Boat 

Length and Beam

Cruising Speed 

Gas or Diesel 

VHF Radio 

Sleep Aboard?

MMSI# 

GPS? 

Do you own a dinghy?

Draft 

Make

DESCRIPTION OF VESSEL

Have you or your spouse/significant other ever been convicted of a crime?  If yes, please explain.

Have you or your spouse/significant other ever been denied membership or expelled from any cloub?  If yes, please explain.

PERSONAL INFORMATION

MEMBERSHIP APPLICATION

Captain's Name 

Birthday  (mm/dd) 

Captain's Cell  

Occupation 

Anniversary

Home Phone 

First Mate's Name 

FM Birthday (mm/dd) 

First Mate's Cell  

Occupation 

Home Address

City

Zip

Referred by