[ ] New Membership [ ] Renewal Membership Sponsored
by: ________________________
Yearly Fee:
$70.00 Per Family (2 Adults and Children under 21 ) and $35.00 for single membership.
LAST NAME FIRST NAME
MIDDLE INITIAL
Mr/Mrs/Ms ____________________________________________________________________
Mr/Mrs/Ms ____________________________________________________________________
ADDRESS_____________________________TOWN________________ST:______ZIP______
Phone:________________________________E-Mail Address:___________________________
Boat Name:__________________________ Boat Type: Sail or Motor
(cirlce one)
CHILDREN UNDER 21:
Name:____________________________________Age:________
Name:____________________________________Age:________
Name:____________________________________Age:________
Name:____________________________________Age:________
PLEASE MAKE YOUR CHECK PAYABLE TO "CCYC 2005" AND FORWARD ALONG WITH THIS COMPLETED FORM MY MAY 15, 2005 TO:
Elbert Mueller - CCYC MEMBERSHIP - 521 Anthony Avenue - Toms
River, NJ 08753
Members and their guests, hereby agree to indemnify and hold harmless Cozy Cove Yacht Club Inc., and it's
Officers, as well as Cozy Cove Marina, and it's employees from and against any and all loss, damage, liability, claims, demands,
and cost for property damage or personal injury arising out of any Club sponsored Activities. I, or we, have read and do agree
to the clause above and by-laws established by CCYC.
SIGANTURE:___________________________ DATE:_____________
_
