Pasquotank River Yacht Club

P.O. BOX 612

ELIZABETH CITY, NORTH CAROLINA 27907-0612

APPLICATION FOR SLIP SPACE - LEGAL OWNER AND YACHT CLUB MEMBER APPLYING:

Date:______________ NAME:____________________________________________

MAILING ADDRESS: ____________________________________________________

_____________________________________________________________________

_____________________________________________________________________

PRIMARY RESIDENCE ADDRESS (if above is a PO Box):

_____________________________________________________________________

____________________________________________________________________

Telephone:________________________ day _______________________evening

Emergency Contact Name:___________________________ Telephone:___________

Boat Information: You must file a copy of your registration or document with application

Make:___________________________ Length:_________ Beam:______Draft: _____ Mfg Year:_____

Type of Boat: ð Sail ð Power Insurance Policy Number:_______________________

Insurance Company:________________ Local Agency:________________________

Local Phone:________ (Copy of Policy Coverage, you must maintain an up to date copy with club)

(you may not occupy a slip until you have executed a lease agreement, signed the marina rules, and filed a current copy of boat insurance declaration and boat registration)

*SPECIAL CONSIDERATIONS:____________________________________________

Give two yacht club member names as references:_____________________________

*Please list any special requirements, i.e. shore power, water connections, limited maneuverability, etc.

FOR PRYC ADMINISTRATIVE USE ONLY:

Date Received By Rear-Commodore:__________ Date Voted for Approval by the Board:________

Results of Vote:______________________________________________________________________

Date of Letter to Applicant:_________________ Signed:_____________________Rear-Commodore