Safety Harbor Boat Club
"Promoting Safe Recreational Boating"
P.O. Box 412
Safety Harbor, Fl. 34695-0412

www.safetyharborboatclub.com/

MEMBER/APPLICANT INFORMATION
$25.00/year Family Dues (**for immediate family)


Applicant Name(s): __________________________________              Date: ________________
(Please print)
                   __________________________________
                   
                   __________________________________

Address: _______________________________________________	

City: _________________________________   	State: _____	Zip: _____

Home Phone: ____________________        Business Phone: ____________________

Cell Phone: ____________________        E-Mail Address: __________________________________

Name of Boat: ___________________________   Type: ________	Length: _______Ft.

       Draft: ________________   Anchorage: _________________   Slip #: _____
					
List Any Other Nautical Affiliations: ____________________________________________________

   _______________________________________________________________________________________


Boating Certification Courses Completed: _________________________________________________

   _______________________________________________________________________________________


Brief Description of Your Boating Experience: ____________________________________________

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Would Be Interested In: (Check as many as you like) 
    1 Crewing for another boat member: ______ 
    2. Help to organize activities ______
    3. Membership Committee: ________  
    4. Event Planning _______  
    5. Other________________________________________________

** Immediate family is Applicant, Spouse, and Children living at home.