Lake City Yacht Club
New Member Application

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Membership Applied For:
(annual dues shown in parenthesis)

Regular ($200.00)
Crew ($35.00)
Associate ($35.00)

All new Regular members pay an initiation fee of $300.00 in addition to annual dues. Membership is pending board approval.
Last Name First Name
Spouse Last Name Spouse First Name
Address City State Zip
Home Phone    
His Email Her Email
His Phone Her Phone
Winter Address (if different) City State Zip
Winter Phone    
       
Child 1 (Name YOB) Child 2 (Name YOB)
Child 3 (Name YOB) Child 4 (Name YOB)
Child 5 (Name YOB)    
       
Boat Name Slip Number
Boat Manufacturer Boat Model
Boat Length    
Mailing Lists Main



 Spouse



  

Please send a check covering initiation fee and dues, payable to Lake City Yacht Club to:
Lake City Yacht Club
c/o Marie Dotseth
812 Fairmount Ave.
St. Paul, MN 55105