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Ladysmith Yacht Club
New: ________ OR Renewal:_____ (Renewals due by December 31, 2009) Member's Name: ____________________________________________ Spouse/Partner (if Family Membership): __________________________ Address: _____________________________PO Box _______________ City: ________________________________ Postal Code: ___________ Phone (Home): ____________________ (Business): ________________ E-Mail (Please write clearly): ___________________________________ Junior members (dependants per rules 4) 10 to 18 years of age, inclusive: Name: _________________________ Age: _______ Name: _________________________ Age: _______ Boat Type: Power:___ Sail: ___ Boat Name:___________________________ Length: ______ Moorage Location (Where are you currently moored, if applicable): ________________________
Dues and Fees Initiation (new members only) $500.00 $ _______ Family Membership @ $125.00 / year $ _______ (couple, or couple & minor children)
OR
Single Member @ $100.00 / year $ _______
OR Corporate Member @ $220.00 / year $ ________
PLUS
Ladysmith Rescue Soc (optional donation) $ ________ TOTAL: Pay to Ladysmith Yacht Club $ ________
The above information is for the records of the
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