| E A S T E R N S H O R E S A V E N T U R A Y A C HT C LU B www.esayc.com Membership Application Date: |
CAPTAIN'S NAME _____________________________________________ BIRTHDAY (month and day)
FIRST MATE'S NAME __________________________________________ BIRTHDAY (month and day)
ANNIVERSARY(month and day)
HOME ADDRESS HOME PHONE
WORK PHONE
FAX
OCCUPATION ______________________________________ CELL PHONE
SPONSOR __ __________________________________ E-MAIL ADDRESS
FIRST MATE'S 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 DINGHY? ________________
LENGTH and BEAM ________________________ DRAFT __________ CRUISING SPEED _________________
VHF RADIO? ________MMSI#_________ GPS? __________DO YOU OWN 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
______________________________________________________________________________________________
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 ________ Financial ________ Club Photographer _____ Newsletter ________
Fishing _____ Good and Welfare ________ Port Captain ______ Fleet Captain____________
Other (All suggestions welcome)_______________________________________________
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
2500 Parkview Dr, Apt 2414 (ANNUAL DUES )
HALLANDALE BEACH, FL 33009 PAYABLE TO: EASTERN SHORES AVENTURA YACHT CLUB
Applicants, with boats capable of overnight cruising, are considered for membership after
attending two club functions.
attending two club functions.
