Lorain, OH 44053-1620

216-314-4521

MEMBERSHIP APPLICATION AND QUESTIONNAIRE

All prospective applicants will receive consideration for membership without

discrimination because of race, creed, color, sex, age, national origin, or handicap.

Dues are $145 plus tax, $154.79 and $100 initiation fee totaling $254.79.

Name_________________________________________________________ Date of Birth _______________

Address __________________________________________________________________________________

City ____________________________________________________ State_______ Zip __________________

Phone # ____________________________________ Cell # ________________________________________

Email______________________________________ Occupation ____________________________________

Employer___________________________________ Work # _______________________________________

Spouse’s Name______________________________ Occupation ____________________________________

Employer____________________________________ Work # _______________________________________

Names and ages of children under 21 __________________________________________________________

________________________________________________________________________________________

Boat Name__________________________________ Make ________________________________________

Registration #___________________________ Year__________ Length__________ Years Boating________

Dock Location _____________________________________________________________________________

Boater’s Education Courses (If so, explain) ______________________________________________________

Are you now, or ever been, a member of another social club (boat, yacht, car, etc.)? If so list the club’s name(s)

and dates of affiliation and reason for leaving. ____________________________________________________

________________________________________________________________________________________

I understand that if I am accepted as a member in the Beaver Creek Boat Club I must abide by the established by-laws of the Club. I further state that my answers to the above questions are true to the best of my knowledge .I further understand that my membership in the Club may be terminated for any intentional falsification of this application.

Signature_________________________________________________________ Date_______________

Member present at time of application _____________________________________

Sponsor (if any) _______________________________________________________

Executive Committee Approval by (list below):