Membership & Berth Application

Personal Contact Information

Applicant's Name (First & Last)*

Street Address*

City*

Province* ABBCMBNBNLNSNTNUONPEQCSKYT

Postal Code*

Home Phone #*

Cell Phone #

Email Address*

Boat Information

Type* SpeedboatSailboatCabin Cruiser

Hull Material* WoodFiberglassAluminumSteel

Year Built*

Gross Weight (in lbs)*

Length (in ft. including bowsprit, swim platform, etc.)*

Beam (in ft.)*

Name of Boat*

Port of Registry*

Registration #*

--- OR ---

Boat License #

Draft

Engine Type GasDiesel2 Stroke HP4 Stroke HP

Crew MemberSocial Member

Application Date*

By checking this box: you are allowing the Lewisporte Yacht Club (LYC) to process this application and you are accepting the LYC membership terms, as well as stating that all information within this application is accurate and truthful.