THE LOUISVILLE SAILING CLUB

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- Fill out the form and send it to:  Eugene Cox
                                     7210 Wood Briar Place
                                     Louisville, KY 40241 

FULL NAME____________________________________  BIRTH DATE____ /____ /____

ADDRESS__________________________________________________________________ 

CITY_________________________________________  STATE______ ZIP:__________

EMAIL ADDRESS________________________________  PHONE(H)__________________

OCCUPATION___________________________________  PHONE(W)__________________ 

SPOUSE'S NAME________________________________  BIRTH DATE____ /____ /____ 

OCCUPATION___________________________________  PHONE(W)__________________

CHILDREN:  NAME______________________________  BIRTH DATE____ /___ /_____

           NAME______________________________  BIRTH DATE____ /____ /____

SAILING EXPERIENCE_______________________________________________________

MEMBERSHIP APPLIED FOR:
     ____REGULAR   ___SENIORR  ____ASSOCIATE  ____JUNIOR  ____JR ASSOCIATE

INTERESTED IN:   _______RACING    ________DAY SAILING     ________CREWING

BOAT CLASS/BUILDER____________________________ SAIL NUMBER_______________

BOAT CLASS/BUILDER____________________________ SAIL NUMBER_______________

I HAVE READ THE BY-LAWS AND AGREE TO THEM.

SIGNED________________________________________ DATED_____ / _____ / _____

SECONDED BY_________________________ SECONDED BY_________________________

LSC USE ONLY: MEMBERSHIP APPLIED FOR__________________________________ INITIATION FEE_________ CURRENT YEAR DUES_________ DOCK FEE_________ TOTAL AMOUNT DUE________ AMOUNT PAID________ DATED____ / ____ / ____