Name *

First Name

Last Name

Address *

Primary residence.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Daytime Phone *

(###)

###

####

Mobile Phone

(###)

###

####

Date of Birth *

MM

DD

YYYY

Spouse Phone

(###)

###

####

Spouse Date of Birth

MM

DD

YYYY

Member Sponsor #1

Please provide the name of 2 current members who will sponsor your application. If you do not have sponsors, please contact the Club Office to arrange for an interview.

First Name

Last Name

Member Sponsor #2

First Name

Last Name

Type of Membership Requested *

Family

Individual

Under 40 years (oldest member of household)

Non-Resident (3 months or fewer on Shore per year)

Junior

Please send statements by: *

Email

Mail

If elected to membership, I agree to pay all the regular dues, fees and charges, plus tax, that may be applicable in the group of membership to which I am elected for at least one year. At the end of each membership year, my membership will automatically renew unless I advise the Club in writing of my intent to change my membership status. I understand that I am responsible for the conduct of my guests and all members of my family and will ensure that they comply with and observe the By-Laws, rules and regulations now in force and those which may be legally adopted. *

By checking this box, I confirm that I have read and agree to the above terms of membership.