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Landline phone

Mobile phone number

Home address

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Additional address details (optional)

Zip code

City

Country

State

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Additional Contact Info

Associated Member Name

If you currently own a boat please provide the following information

Boat Name, Boat Type, Boat Length & Mooring Location

Would you offer your boat as a race committee boat?

Years Boating

What are your specific interests within the club? (check all that apply)

Interest Area

Lake Small Boat Instructor (US Sailing certification required)

Lake Small Boat Sailing

Lake Sunfish Racing

Ocean Crewing

Ocean Cruising

Ocean Racing

Other

Social Events such as Happy Hours

Please check the committees on which you are willing to serve

Kids Learn To Sail Registration

Kids Information

Sailor's Name

DOB

Address

City/State

Zip Code

Primary Email

Mother's Name & Phone Number

Father's Name & Phone Number

Insurance Information

Insurance Company

Insurance Phone

Group #

ID #

EMERGENCY CONTACT INFORMATION

Emergency Contact Name

Phone

Relationship