PGIslanders Cruising Club Membership Application

LAST NAME _____________________________________________
FIRST NAME______________________________________________ BIRTHDAY (Mo/Day)___/____
SPOUSE/SIG. OTHER _______________________________________ BIRTHDAY (Mo/Day)___/____
PGI STREET ADDRESS ______________________________________________________________
PGI PHONE________________________________________ CELL __________________________
OTHER ADDRESS (if seasonal) _____________________________________________________
OTHER CITY/ST/ZIP __________________________________ OTHER PHONE_________________
E-MAIL ADDRESS ____________________BOAT MFG/MODEL _______________POWER/SAIL______
BOAT NAME: _________________________________LENGTH ______BEAM ______ DRAFT _____
BOATING RELATED EXPERIENCE, HISTORY, CERTIFICATION, ETC (I.E. POWER SQUADRON,
COAST GUARD, CHARTERS)____________________________________________________________

COMMITTEE INTEREST: (please check one or more)
MEMBERSHIP__ CRUISE SELECTION__  WEBSITE/COMMUNICATIONS__  SOCIAL__ EDUCATION__

NAME BADGE INFORMATION (please print)
LAST NAME __________________________ HIS FIRST NAME_____________________________
HER FIRST NAME _____________________ BOAT NAME __________________________________
WHICH MONTHS ARE YOU NOT IN PUNTA GORDA?
JAN__ FEB__ MAR__ APR__ MAY__ JUN__ JUL__ AUG__ SEP__ OCT__ NOV__ DEC__

IMPORTANT: THERE MAY BE A WAITING LIST TO BECOME PGISLANDER MEMBERS. DO NOT SEND YOUR DUES UNTIL THE MEMBERSHIP CHAIRMAN CONTACTS YOU INDICATING THERE IS AN OPENING AVAILABLE. NEW MEMBERS ARE TAKEN ON A FIRST COME, FIRST SERVED BASIS DEPENDING UPON THE DATE OF RECEIPT OF THIS MEMBERSHIP APPLICATION.
(YOU MUST BE A MEMBER OF THE PGI CIVIC ASSOCIATION TO JOIN PGISLANDERS CRUISING CLUB.)

COST OF MEMBERSHIP
ANNUAL DUES:                $20.00 PER COUPLE($10.00 for INDIVIDUALS),
CLUB BURGEE:                 $22.00,
NAME TAGS:                     $22.00 ($11.00 EACH),
TOTAL (INITIAL YEAR):  $64.00

SIGNATURE_____________________________________DATE_______________

Office Use Only:
Date approved by board ________________ Date Resigned ________________ Date moved to new status with club _____________