Date

MM

DD

YYYY

Name (Applicant 1)

First Name

Last Name

Name (Applicant 2)

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Phone Number

(###)

###

####

Birthdate (Applicant #1)

MM

DD

YYYY

Birthdate (Applicant #2)

MM

DD

YYYY

Application Membership Category and Type

Please select the membership type for which you are applying

Resident - Boat Owner/Operator ($1,000/yr.)

Resident Family (two individuals in the same household) - - Boat Owner/Operator ($1,500/yr.)

Associate - Boat ownership is not required ($1,000/yr.)

Associate Family (two individuals in the same household) - Boat ownership is not required. ($1,500/yr.)

Affiliate - Boat Owner/Operator; Member of another boating club ($400/yr.)

Social ($200/yr.)