PHONE#_____________________________________________________________

Cell Phone # and Carrier________________________________________________

E-MAIL _____________________________________________________________

BOAT: (Name)__________________________________________________________

Occupation: (past or present)______________________________________________

Work# _______________________________________________________________

Please indicate below with a check mark any of the following Club Activities that you would be interested in becoming involved with:

__Speaker Program __Membership __News Letter __News Letter Mailing

__Banquet __Nominations __Fishing Contest __Club Gear __Officer Of Club

__Advertising For Newsletter __Flee Market __Picnic __Board Of Directors

SPONSOR: Print Name Clearly__________________________________________

If approved, I agree to abide by the By-Laws of this Club.

Signature of Applicant_____________________________________Date__________

Attached: $__$10.00 Initiation Fee

                 $    $30.00 Current year dues

Payment Received: _____________________ $ _________ Check #______________

                                         (Treasurer)

Accepted for Membership: _________________________ Date ____/___/___

                                                (Member of B.O.D.