E A S T E R N   S H O R E S   A V E N T U R A  Y A C H T   C L U B www.esayc.com                                              Membership Application                                  Date:

CAPTAINS NAME _____________________________________________        BIRTHDAY (month and day)                                FIRST MATES NAME __________________________________________         BIRTHDAY (month and day)                                                                                                                                                                                 ANNIVERSARY(month and day)                          HOME ADDRESS                                                                                               HOME PHONE                                                                                                                                                                                                   WORK PHONE                                                                                                                                                                                                    FAX                                                                          OCCUPATION      ______________________________________        CELL PHONE                                                                          SPONSOR                 __________________________________       E-MAIL ADDRESS

DESCRIPTION OF VESSEL

NAME of BOAT_____________________        MAKE ______________________          GAS, DIESEL          _________________ LENGTH and BEAM ________________________         DRAFT __________          CRUISING SPEED  _________________ VHF RADIO? ________    MMSI#_________                GPS? __________        DO YOU OWN A  DINGHY? ________________

PERSONAL INFORMATION

HOW LONG HAVE YOU BEEN BOATING AND WHERE? ________________________________________________________ HAVE YOU TAKEN AND COMPLETED BOATING COURSES IN: U.S. COAST GUARD ______________________________        U.S. POWER SQUADRON                                 OTHER(please list)_________________________________________________ WHAT PROGRAM TOPICS WOULD INTEREST YOU:                                                                                                                                        HAVE YOU OR YOUR SPOUSE/SIGNIFICANT OTHER EVER BEEN DENIED MEMBERSHIP OR EXPELLED FROM ANY CLUB? IF YES PLEASE  EXPLAIN ____________________________________________________________________________ HAVE YOU OR YOUR SPOUSE/SIGNIFICANT OTHER EVER BEEN CONVICTED OF A CRIME? IF YES PLEASE EXPLAIN ______________________________________________________________________________________________

CHECK THE  COMMITTEES  YOU  WOULD  LIKE  TO  PARTICIPATE  IN:

________ Phone Squad                   ________ Membership                ________ Program             ________ Training and Safety ________ Financial                          ________ Club Photographer         ________ Newsletter        ________ Fishing ________ Good and Welfare          ________ Port Captain                     __________  Fleet Captain ________ Other (All suggestions welcome)_______________________________________________

RETURN APPLICATION TO:

Lea Sherman                                                                                  PLEASE ENCLOSE CHECK FOR $ 125              2500 Parkview Dr, Apt 2414                                                                          (ANNUAL DUES )               HALLANDALE BEACH,  FL  33009                                           PAYABLE TO: EASTERN SHORES AVENTURA YACHT CLUB

Applicants with eligible boats are considered for membership after attending two club functions