LAST NAME:             FIRST NAME:         
SPOUSE NAME:   

STREET ADDRESS:        APT.#:   
CITY:            STATE:            
ZIP:   

HOME PHONE with area code:         
WORK PHONE with area code:     
CELL PHONE with area code:    
FAX# with area code:     
E-MAIL:    

BOAT LENGTH:        MODEL:        
BOAT FL NUMBERS:    
BOAT NAME:   

WHAT DO YOU LIKE TO DO:

FISHING         YES     NO
CRUISING       YES     NO
DIVING           YES      NO
LONG TRIPS    YES      NO
SHORT TRIPS  YES     NO
TRAILERING    YES     NO

DO YOU HAVE ANY SUGGESTIONS FOR SPEAKERS?
DO YOU HAVE AND SUGGESTIONS FOR TRIPS?

DUES ARE $25.00 PER YEAR
YOU WILL RECEIVE A BILL FOR YOUR DUES.