2008
NEW MEMBERSHIP
or REWNEWAL FORM |
| |
| Captain's Name: ______________________________ |
| Captain's Birthday: ____________________________ |
| month/day |
| First Mate's Name: ____________________________ |
| First Mate's Birthday: __________________________ |
| month/day |
| Anniversary: _________________________________ |
| month/day |
| Address: ____________________________________ |
| City: _______________________________________ |
| State: _______________________ Zip: ___________ |
| Home Phone/Area Code: _______________________ |
| Work Phone/Area Code: _______________________ |
| Email Address(s): ___________________________ |
| ___________________________ |
| Boat Name: _________________________________ |
| Length: ________________ Beam: _______________ |
| MC#: ______________________________________ |
| Home Port: __________________________________ |
| Power or Sail: ________________________________ |
| |
| Dues: $50.00 Family/Year |
| |
| Checks payable to: GPWBC |
| |
| Return completed form and check to: |
P/C John Fougerousse
1956 Hutchins Dr.
Rochester Hills, MI 48309
(248) 375-5282 |
