Membership Application

CAPTAIN__________________________ 2nd MEMBER (Spouse, Co-owner,etc.)__________________

ADDRESS__________________________________ Phone_______________________

__________________________________ e-mail_______________________

__________________________________ Fax_________________________

Cell Phone ___________________

BOAT NAME________________________________ Mfg/Type_____________________

SAIL #________________HULL COLOR__________________________

INBOARD_________OUTBOARD_________________

MOORING SITE______________________________________________SLIP#_____________

INTEREST (Check all that apply) Cruising________________ Racing_____________

I want to receive my newsletter viaE-mail Snail Mail (US Postal Service)

Check one Category:

___________Full Member ($20.00): C-27 Captain, one additional person and children under 18 yrs.

___________Associate member ($20.00): Non C-27 Captains, one additional person and children under 18 yrs

___________Family Members over 18 yrs. Fee $5.00 each. NAMES___________________________________

Total Payment: ____________________Make checks payable to “FLEET 19” and mail to:

John Jennings
Treasurer
5259 Lightfoot Path
Columbia, MD 21044
410-992-0651

Annual dues are payable at or before the Re-organization Dinner Party (March)

I release Catalina Fleet 19, its officers, committees, and members from any and all liabilities for direct or indirect damages or injuries that occur during Fleet activities.

Signature of Owner/Captain: __________________________________________________Date:___________________

Note: This is not IC-27SA membership