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

www.geocities.com/safetyharborbc/

MEMBER/APPLICANT INFORMATION


Applicant Name(s): ____________________		Date: ______
                   ____________________
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Address: ______________________________	

City:	_________________________________   	State: _____	Zip: _____

Home Phone: ______________			Business Phone: ___________

Cell Phone:	______________			E-Mail Address: ___________

Name of Boat: ___________   Type: _____	Length: _____

  Draft: ____	Slip #: _____
					
List Any Other Nautical Affiliations: ___________________________
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Boating Certification Courses Completed: ________________________
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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________________________________________________