Application for Active Membership

Application for Active Membership

    Type (Required):

    Name 1: Email 1:
    Cell 1:

    Name 2: Email 2:
    Cell 2:

    Name 1:

    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: