Portsmouth Boat Club

Membership Application Form

First Name

Middle Name

Last Name

Nickname

First Mate

Address

Phone #1 (Preferred)

Cell

Phone #2

Email -- Member

Email -- First Mate

Boat Name

Boat Make & Model

Boat Size

Boat Year

Boat type

Sail

Power

Boat Location

PHRF Class

PHRF Rating

I have read and understand the Club By-Laws and will abide by them and other Club Rules (including any posted Rules).

Signature

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Date

Month

Day

Year

Name of Sponsoring Member #1

Name of Sponsoring Member #2

Pay Initiation Fee and Dues

Initiation Fee ($200) and Dues ($300)

$500

Dues are pro-rated on a monthly basis based upon an April 1-March 31 membership year.. You are charged for the full month in which your Membership is approved by the Board. Any excess amount of Dues collected will be refunded promptly following approval of Membership.

FOR CLUB USE ONLY

Board Approval Date:

Membership Approval Date:

Member Status Dates

Member #:

Issued Card & Member #:

Issued Package:

Added to Roster:

Added to Email List: