Captain First Name:     Mate First Name:

Last Name:

Street Address:   

City:        State:    Maryland Pennsylvania Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington West Virginia Wisconsin Wyoming     Zip: -

Home Tel:    () -    Bus Tel:    () -

Boat Tel:    () -    Fax Tel:    () -

Employer:   

Boat Name:   

Boat Length:     Boat Beam:     Electric Reqs: 1-30 Amp Cord 2-30 Amp Cords 1-50 Amp Cord 2-50 Amp Cords None Other (Please Write In)

Home Port:

Email Address: @.

Captain Birthdate: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Mate Birthdate: January February March April May June July August September October November December Not Applicable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 N/A

Anniversary: January February March April May June July August September October November December Not Applicable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 N/A

Two Sponsors Are Required. Please type their names here:

Sponsor 1:

Sponsor 2:

We/I, the undersigned applicant(s), desire to be member(s) of Maryland Cruising Club, Inc. We/I are interested in participating in social and boating activities and assisting in the improvement of pleasure boating on the waterways of the Chesapeake Bay and its tributaries. As member(s), we/I agree to abide by the By-Laws and other regulations as now written or as legally amended.

2003 Rates For Membership are as follows:

Initiation Fee: $20 (Twenty Dollars)

Annual Family Membership: $73 (Seventy-Three Dollars)

Annual Single Membership: $46 (Forty-Six Dollars)

If paying for a portion of the current year,  the membership dues shall be pro-rated as follows:

October, November, December = 100%

January, February, March = 75%

April, May, June = 50%

July, August, September = 25%

I understand that if for any reason, this application should be rejected, this total amount shall be promptly refunded to me!

Applicant Signature:                                                      Date:    __________

Sponsor Signature:                                                        Date:    __________

Sponsor Signature:                                                        Date:    __________

Find a check to cover the initiation and membership fees in the total amount of:

(Oct, Nov, Dec) $93 - Family Membership Plus Initiation Fee (Jan, Feb, Mar) $74.75 - Family Membership Plus Initiation Fee (Apr, May, Jun) $56.50 - Family Membership Plus Initiation Fee (Jul, Aug Sep) $38.25 - Family Membership Plus Initiation Fee (Oct, Nov, Dec) $66 - Single Membership Plus Initiation Fee (Jan, Feb, Mar) $54.50 - Single Membership Plus Initiation Fee (Apr, May, Jun) $43 - Single Membership Plus Initiation Fee (Jul, Aug, Sep) $31.50 - Single Membership Plus Initiation Fee

Please fill out the above application, sign & date

Make check payable to:

Maryland Cruising Club

Mail form and check to:

Commodore Donald Antos