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1. Personal Information

Membership Type: *

First Name: *

Last Name: *

Address 1: *

Address 2:

City: *

State: *

Zip Code: *

Home Phone: *

Account information

Username: *

Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

2. More About You

Coast Guard Licensed?:

Boating Experience Level:

(use your best judgement)

More Information:

Tell us a little more about you, your boating interests and experience, why you joined the club, etc.

3. Signifigant Other

Name:

E-mail:

4. Boat Information

Boat Name:

Make/Model:

Length (feet):

Boat Type:

Harbor:

Boat Phone:

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