Lake_Monroe

 

Application

boatclub title

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MEMBERSHIP APPLICATION

 Name____________________________________         Date__________________

 Phone #’s: Primary (____)_____________ Alternate (____)______________

 Email: ______________________________________________________

Address___________________________________________________________
                    Street                                           City                ST                        ZIP

 Driver’s License_____________________________Date of Birth____________

 Emergency Contact _________________________________________________
                                            Name                        Phone                        Relation

 Please list existing marine/sailing/boating organization or club membership(s):
 

Organization

Membership Number

Florida Boating Safety Identification Card

American Sailing Association

US Sailing

Boat US

List any formal training you have had in boating, sailing, or flying, such as Coast Guard Auxiliary, ASA, US Sailing, Power Squadron, Red Cross, Private Instruction, Civil Air Patrol, Commercial Pilots License, Merchant Marine Captain, Mate, Deck Hand, etc.List types of previously sailed vessels/boats and years of experience on each type:

 

List types of previously sailed vessels/boats and years of experience on each type:

 

Briefly tell us about your sailing or boating experience:

 

 

List potential crew (including sailing experience) and relationship:

 

Signature X_____________________________           Date:_____________