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New: _____
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Renewal: ___ (Renewals due by December 31, 2009)
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Junior Member's Name: ___________________________________________
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Address: _________________________________________________________
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City: ___________________________
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Postal Code: ____________
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Phone (Home): ___________________
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(Business): _____________________
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E-Mail (Please write clearly): _______________________________________
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Boat Type: Power:___ Sail:____ Boat
Name:__________________ Length: ____
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Dues and Fees
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Initiation
(new juniors only)
$30.00
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$ _________
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Junior @ $15.00 / year
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$ _________
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PLUS Optional Donations
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Marine Parks Forever (optional donation)
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$ _________
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Ladysmith Rescue Soc. (optional donation)
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$ _________
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TOTAL:
Pay to
Ladysmith Yacht Club
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$ _________
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The above information is for the records of the
Ladysmith Yacht Club. It may be used in the
publication of the annual club roster.
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Parent/Guardian Signature (Required):
________________________
Signature of Junior Member(Required):
________________________
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