Membership information form | Miramar Yacht Club

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Membership Information

Please take a moment to fill out the form.

First and Last Name

Email

Phone

Address

Apt.

Spouse/Partner's First and Last Name

Spouse/Partner's Email

Spouse/Partner's Phone

Address

Apt.

Full name of underage member #1

Date of Birth

Full name of underage member #2

Date of Birth

Membership Type *

Boat Owner

Non-Boat Owner

Ready Boat Share

Has Engine

Name of Boat #1 (if applicable)

Registration State & Number

Make and Model

Length

Weight

Insurance Policy & Number

Engine Type (N/A if none)

Mooring or slip no.

Name of Boat #2 (if applicable)

Registration State & Number

Boat Make and Model

Length

Weight

Insurance Policy & Number

Engine Type (N/A if none)

Mooring or slip no.

Small Craft

Dinghy

Motor

Sail Fish

Surfboard

Rower

Other

None

Small Craft Description

Storage Area

Color

ID

Length

Weight

I approve distributing my info to the membership via

Email

Log

Newsletters

Cell

Mail

Forum

None

We are a cooperative organization. Members are expected to volunteer at least 5 hours each year or pay a $200 assessment. How would you like to volunteer? List your skilfs and pqeferences below:

Emergency Contact Phone Number

Name

Relationship

Thanks for submitting!

3050 Emmons Ave
Brooklyn NY 11235

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