THE WESTERLY YACHT CLUB

2017-2018APPLICATION FOR ACTIVE MEMBERSHIP

NOTE: TO BE CONSIDERED FOR MEMBERSHIP

1.All questions must be answered in full.

  1. This application must be returned to the Commodore of the Westerly Yacht Club.
  2. A request for reinstatement requires documentation that you left the Club in good standing.

Please PRINT or TYPE all information

Name: Home Phone:

Cell Phone:

Current Residence:

City: State: Zip Code:

E-mail Address:

Mailing Address (If other than above):

Date of Birth: Age:

Single: (or if) Married: Spouse Name:

Have you ever been convicted of a felony?

Employer: Phone:

Street Address:

City: State: Zip Code:

Occupation:

I, the undersigned:

  1. Authorize your committee to verify my references;
  2. Agree, that if elected to membership in the Westerly Yacht Club, will conform to, and abide

by its rules and by-laws;

  1. Declare that the information I have provided is true and correct.

Applicant Signature: Date:

By signing this application I give my consent for a background check to be executed.

Print Applicant Name:

Proposing Member Signature: Date:

Print Member Name: Phone:

CHECK IF APPLICANT IS SON or DAUGHTER OF PROPOSING MEMBER

 CHECK IF APPLICANT IS MOTHER OR FATHER OF PROPOSING MEMBER

Please list three (3) character references, other than your sponsor (No Relatives).

NameAddress (Include City, State and Zip)Phone

1)

2)

3)

Why do you want to become a Westerly Yacht Club (WYC) member?

Have you previously applied for membership to the WYC? If yes, when?

Do you own a boat? Name of your boat:

Power or Sail: Length: Beam: Draft:

Are you a member of the USCG Auxiliary or US Power Squadron?

Were you ever a member of this club or any other yacht club?

Please list current members who are related to you and their relationship:

If you are elected to Westerly Yacht Club Membership, the following 2017/18dues and fees shall be paid within seven days of your written notification.

Initiation Fee:$800.00

Annual Dues:$590.00 Total: $1,463.00

Assessments:$ 73.00

NOTE: The Initiation Fee is not applicable to those applying for reinstatement.

Card keys and parking decals are to be used solely by members of the Club to gain admittance to the property and Club House. If elected to membership, you may have one (1) additional card key and parking decal for your spouse, if needed. Card keys and decals are at no time transferable to non- club members.

Number of Card keys: ______Number of decals required: ______

______

FOR MEMBERSHIP COMMITTEE USE

The applicant was interviewed on , and was was not

recommended for Active Membership.

David C. Robertson Jr.– Chairman

William D. ArmstrongRonald Lawrence, PC

Larry GavittRobert A. Mandes, PBoD

David Miguel, PC Robert Bongiolatti

FOR OFFICE USE

Fees Received: (AMOUNT & DATE) Decals / Key Cards Prepared: