Summer Privileges Renewal

Summer Privileges Renewal

    Type (Required):

    Duration (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 Summer Residence: Address Permanent Residence:
    Address:
    City:
    State:
    Zip Code:
    Telephone:







    Previous MIYC Summer Privilege?

    (most recent year)

    Boat Information:

    Name: Length: Make: