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 _____

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 __________________________________

BOATING RELATED EXPERIENCE, HISTORY, CERTIFICATION, ETC (I.E. POWER SQUADRON,

COAST GUARD, CHARTERS)____________________________________________________________

WHICH MONTHS ARE YOU NOT IN PUNTA GORDA?

JAN__ FEB__ MAR__ APR__ MAY__ JUN__ JUL__ AUG__ SEP__ OCT__ NOV__ DEC__

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.