Name___________________________________________________________
Street Address____________________________________________________
City________________________________ State_____________ Zip________
Home Phone (_____)________________________
Work Phone (_____)________________________
Email________________________________________________
Hull #______________________________________ Sail #________________
Boat Name___________________________________________
Number of years you have owned your boat? ______
I am a:
Skipper/Owner( )
Crew/Owner ( )
Crew ( )
Interested observer ( )
Local Club Affiliation:
Club Name________________________________________________________
Club Location______________________________________________________
Number of Mutineers in your club_______
Type of Membership:
(Check One) Full ( ) (Boat owner, Voting rights)
Associate ( ) (Any person having an interest in the Class, Non-voting)
This Membership is:
(Check One) New ( )
Renewal ( )
Annual Dues: $25 Full membership (You may pay for a maximum of three years)
$15 Associate membership (You may pay for a maximum of two years)
Years for which you are paying: 20___ and 20___
Total Amount Enclosed: $_________________
Make Checks Payable to : Mutineer 15 Class Association
Send application and payment to: Mutineer 15 Class Association
Attn: Gordon Brookfield
101 Ficus Court
Parrish, FL 34219