Application for Active Membership


Type (Required):


Name 1: Email 1: Cell 1:

Name 2: Email 2: Cell 2:

Child/Children:

Name: Age: DOB:
Name: Age: DOB:
Name: Age: DOB:
Name: Age: DOB:

Address Residence: Address Secondary:
Address:
City:
State:
Zip Code:
Telephone:









Previous association with MIYC other than Summer Privilege? (family, guest, other)


Primary Sponsor #1 Primary Sponsor #2
Name: Name:
Email: Email:

Names of 3 membership & guest committee members that know you:

1) 2) 3)

Boat Information:

Name: Length: Make: