Couple Membership Form
Captain information
First Mate information
        Note: if same as Capt, leave blank
First Name
   
Last Name
   
Street Address
   
City
    
State
    
Zip
    
Home Phone
   
Cell Phone
   
Work Phone
   
Fax Phone
   
Email
    
Occupation/Company
    
Website URL
   
Birthday
  Month Day   Month Day
Boat Name
   
Boat Description
   
Boat Location
   
Boat Slip Number
   
Willing to
volunteer for 		 
Artwork Events
Bartend Galley
Carpentry Grounds
Clerical Newsletter
Decoration Painting
Electrical Photos
Engineer Plumbing
Entertain Welding
Other
 
Artwork Events
Bartend Galley
Carpentry Grounds
Clerical Newsletter
Decoration Painting
Electrical Photos
Engineer Plumbing
Entertain Welding
Other
Boating courses taken:
       
Coast Guard
   
Power Squadron
   
Other
    
other Yacht Clubs you are
or have been a member of:
   
Sponsor Name      
enter Check Number   Bring check to interview