Street Address:

City: , State: Zip:

Home Phone: ; Cell Phone: ; Work Phone:

E-mail: Primary ; Second

Boat Name:

Boat Type (e.g., H380) & Year:

LOA: ; BEAM: ; DRAFT: ; Mast Ht (AWL):

Marina Name: ; SLIP #:

Location:

Is your boat insured? YESNO --- Has your boat passed USCGA/USPS Vessel Safety Check? YESNO

Co-Captain or
First Mate Name:

2nd Mate: ; DOB:

3rd Mate: ; DOB:

4th Mate: ; DOB:

Birthdays: Captain: ; First Mate: ; Anniversary:

Do you race? YESNO

CBYRA Member? YESNO --- Sail No. ; PHRF Rating:

Licensed Captain? YESNO --- Tonnage: ;Expiration:

Desired Education:

Fill in the form COMPLETELY; then print out and mail with your check for annual dues to:

Marie Frankel
2008 Kurtz Avenue
Pasadena, MD 21122

Make checks payable to: NSHSA. Annual Dues for Regular Membership - $35 - due to Purser by 28 FEBRUARY.

For additional information, contact Purser Marie Frankel