Duck Island Yacht Club

Duck Island Yacht Club - Membership Application

DUCK ISLAND YACHT CLUB Inc.
PO BOX 593 * WESTBROOK, CONNECTICUT 06498
APPLICATION FOR MEMBERSHIP

TYPE OF MEMBERSHIP (check one)  ____Active  ____Conditional ____Social

Name_____________________________________________________________________
	Last			First		Spouse

Address__________________________________________________________________
     Street		   City			State	 Zip

Home Phone________________Fax________________E-mail_____________________

Children (names and ages)_______________________________________________

Occupation (Applicant)_______________________Company____________________

Work Address_____________________________________________________________
  	   Street		 City	        State Zip    Phone

Occupation (Spouse)__________________________Company_____________________

Work Address_____________________________________________________________
  	   Street		 City	        State Zip    Phone

Boat Name_______________Make____________Type___________Sail #___________

Boat Location___________________________________________________________

Proposed By:____________________________________________________________

Seconded By:________________________Seconded By:________________________

Proposer and Seconds must recommend applicant for membership by letter to
Secretary, DIYC

Member Responsibility: I understand the success of Duck Island Yacht Club requires 100% involvement of its members. I agree to do my part as an active contributor to the work responsibilities of the club.

The applicant understands and agrees to all of the requirements of 
Active Membership and to comply with all DIYC rules and bylaws.

Applicant's Signature______________________________Date_______________

Please forward application with all required fees(see Membership Options)to:

Secretary, Duck Island Yacht Club, P.O. Box 593, Westbrook, CT 06498