MEMBERSHIP APPLICATION
Name____________________________________ Date__________________
Phone #’s: Primary (____)_____________ Alternate (____)______________
Email: ______________________________________________________
Address___________________________________________________________ Street City ST ZIP
Driver’s License_____________________________Date of Birth____________
Emergency Contact _________________________________________________ Name Phone Relation
Please list existing marine/sailing/boating organization or club membership(s):
Organization
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Membership Number
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Florida Boating Safety Identification Card
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American Sailing Association
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US Sailing
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Boat US
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List any formal training you have had in boating, sailing, or flying, such as Coast Guard Auxiliary, ASA, US Sailing, Power Squadron, Red Cross, Private Instruction, Civil Air Patrol, Commercial Pilots License, Merchant Marine Captain, Mate, Deck Hand, etc.List types of previously sailed vessels/boats and years of experience on each type:
List types of previously sailed vessels/boats and years of experience on each type:
Briefly tell us about your sailing or boating experience:
List potential crew (including sailing experience) and relationship:
Signature X_____________________________ Date:_____________
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