BEAVER CREEK BOAT CLUB

2012 DUES PAYMENT FORM

Please pay your 2012 dues using this form:

(We) _____________________________, will be returning as a member of Beaver Creek Boat Club.

(We) _____________________________, will not be returning as a member of Beaver Creek Boat Club.

Please select from the following payment plans:

3-Month Installment: $48.00 + $3.00 = $51.00 due on or before September 15, 2011

$48.00 + $3.00 = $51.00 due on or before October 15, 2011

$49.00 + $3.10 = $52.10 due on or before November 15, 2011

2-Month Installment: $72.50 + $4.55 = $77.05 due on or before October 15, 2011

$72.50 + $4.55 = $77.05 due on or before November 15, 2011

1-Payment of : $145.00 + $9.10 = $154.10 due on or before November 15, 2011

Add $5.00 (one time) for GCBA Patron Ad. Chance to win 2 free tickets to 2011 GCBA Commodores Ball.

If you wish to become a Social Member, please call present Commodore for payment amount. (What is a Social Member? They may attend all social activities; have the code to the Clubhouse but do not have to serve on committees. They have no voting rights and cannot hold an office or appointment.)

Social Membership due on or before November 15, 2011

Late fee will be charged for payments received after November 15, 2011. If other payment arrangements need to be made, please contact our treasurer at the number below.

Make checks payable to Beaver Creek Boat Club

Mail payment(s) to BCBC, c/o Joe DiMarco 4767 Hawk LN, Lorain OH 44053. If you have any questions please call 440-506-0584 or email:treasurer@beavercreekboatclub.com

Name:_______________________________________________________________________________

Address:_____________________________________________________________________

City State Zip:________________________________________________________________

Phone Number:HOME__________________________CELL_________________________

Email Address:_______________________________________________________________