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Membership Applied For:
(annual dues shown in parenthesis)

Regular ($375.00 first year / $325 each year after)
Crew ($35.00)
Associate ($35.00)

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



 

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Membership is pending board approval.