Membership Application

Name (1) _______________________________________________  Name (2) _______________________________________________

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Email address (1) _______________________________________ Email Address (2) _______________________________________

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Address _______________________________________________________________________________________________________  

 

City  ___________________________________________________________ State ______________________ Zipcode____________

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Home / Cell phone (1) ____________________________________  Home / Cell phone ___________________________________

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Diving Qualification/s (1) __________________________________________ (2) ___________________________________________

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Boating Qualification/s (1) _________________________________________ (2) ___________________________________________

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Are You Willing to Serve on a Committee?  (1)  Yes    No     (2)   Yes    No

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Do you Own a Boat/s?     Yes   No    Are you willing to be Photographed?      Yes   No

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Emergency Notification Name ____________________________________________________________________________________

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Address _________________________________________________ City ________________________ State ______________________

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Phone Number _________________________________________________ Relationship ____________________________________

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I/We agree to abide by the Club Constitution and By-Laws (Click here for the Club Constitution and By-Laws)

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(1) _________________________________________________________ (2) ____________________________________________________

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