PGIslanders Cruising Club Membership Application

NAME
Last
First1
DOB (m/d)
First2
DOB (m/d)
PGI ADDR
Street Address
City
ST
Zip
OTHER ADDR
Street Address
City
ST
Zip
PHONE
PGI Phone
Cell 1
Cell 2
EMAILS
First1
First2
MAIN VESSEL
Name
(P)ower or (S)ail
LOA
Beam
Draft
Manufacturer
ADD'L VESSEL
Name
(P)ower or (S)ail
LOA
Beam
Draft
Manufacturer
ADD'L INFOMATION
MMSI Number
BOATING EXPERIENCE
(Tell us a little bit about your boating experiences - i.e. History, Certifications/Classes Attended, Other Memberships)
HAVE YOU EVER HAD A CERTIFIED SAFE BOATING CLASS?
First1 (Yes/No)
First2 (Yes/No)
FIRST NAMES FOR NAME TAGS:
First1
First2

AREAS OF INTEREST:    Membership  Cruise  Social  Education  Website  Communication

WHICH MONTHS ARE NOT IN PUNTA GORDA?
                          Jan  Feb  Mar  Apr  May  Jun  Jul  Aug  Sep  Oct  Nov  Dec

IMPORTANT: You must be a member of the PGI Civic Association and Not a member of another PGICA Boat Club to join the PGISLANDERS CRUISING CLUB.

AMOUNTS   DUE
Annual Dues ($10.00/person) Note:
Club Burgee ($19.00) The Total amount for 2
Name Tags ($7.00/person) persons is $53.00
INTERNAL USE
Board Approval ____________________ Resignation ____________________ Status Chg ____________________

SEND TO PGISLANDERS MEMBERSHIP COMMITTEE

Click the 'Submit' button to Send the Application to the Membership Committee If you print this form, then send the completed form to:
Gary & Sherry Moerke    
Click 'Reset' to Clear the Form and Start over   1425 Via Milanese    
Punta Gorda, FL 33950