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 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 A  DINGHY? _____________

PERSONAL INFORMATION

HOW LONG HAVE YOU BEEN BOATING AND WHERE? ________________________________________________________ HAVE YOU TAKEN AND COMPLETED BOATING COURSES IN: U.S. COAST GUARD AUXILIARY______________________________ 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, EXPLAIN: _____________________________________________________________________________________ HAVE YOU OR YOUR SPOUSE/SIGNIFICANT OTHER EVER BEEN CONVICTED OF A CRIME? IF YES, 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