Palmer’s Cove Yacht Club

Application for Membership

Instructions

The process to apply for membership in Palmer’s Cove Yacht Club starts with your sponsors. You need two (2) member sponsors to sign your application, effectively recommending you for membership. The application is straightforward, and we require full and complete disclosure by completing each field or question in the application form. The information you provide will be reviewed by the Membership Committee, and any other officials of the Club as may be necessary to determine eligibility and acceptance. In addition, the Club may inquire of outside sources as part of a background investigation. Your submission of your completed application and the accompanying information release is considered your authorization to proceed with the application review process.

Your name will be placed on the membership waiting list in the order in which your application was received with the required $270.00 deposit. The waiting list will determine the sequence of admission to membership based upon available openings. The Club presently has a 350-member limit, and new members are taken from the waiting list each year to fill the limit. Please note that according to Club by-laws, family members of existing members are given preference and may bypass the waiting list and the membership cap.

Please complete the application form and return it with (2) clear portrait photos of yourself to your sponsor with your deposit of $270.00. You may also return it directly to the Membership Committee in care of the PCYC office, 74 Leavitt Street, Salem, MA 01970

Membership Chairmen: Betsy LeBlanc

Email:

Telephone: Lounge 978-744-9722 Office 978-741-2566

Membership Fees (2017) are as follows:

DEPOSIT (with application)$270.00

($60.00 nonrefundable administration fee)

($210.00 refundable, or applied to initial entrance fees)

FEE DUE UPON ENTRY INTO PCYC:

Dues$330.00

Entertainment Assessment$180.00

Launch Fee (required)$ 90.00

Initiation Fee$840.00

MBYCA Fee$ 3.60

Less $210.00 from Application Deposit - 210.00

Total Amount Due Before Initiation Meeting $1,233.60

Palmer’s Cove Yacht ClubApplication for Members
(please print)

Application Date / Applicant
attach face photo here
Date of Birth
Full Name
Street Address
City
State
Zip
Home Phone
Work Phone
Cell Phone
Email Address
Occupation
Auto Type & License Plate # / Year/Make/Model / State & Plate No.
Boat Information / Year/Make/Model / Length/Beam/Draft
 Power /  Sail /  Gas /  Diesel /  Inboard /  Outboard
Boat Name / Own Dinghy?  Yes  No
Boating Education /  Coast Guard Aux  Power Squadron  Other (specify)
Optional Social Information / Married?  Yes  No
Children?  Yes  No / Spouse’s Name
Names/Ages
Hobbies, Special Interests, Skills:
If applicant is accepted for membership, it is expressly agreed that the applicant will abide by the bylaws and any other rules and regulations of the organization. The applicant understands and accepts probation for one year. If membership is terminated for any reason, any keys and other property of the organization will be immediately returned to the club secretary.The deposit of $270.00 includes a $60.00 non-refundable administration fee. Additional fees will be collected following acceptance.
Applicant’s Signature
Sponsor 1 (sign & print)
Sponsor 2 (sign & print)
Approved for membership:
 Membership Committee Approval dated: ______ Board of Directors Approval dated: ______
 Membership Start date: ______ Membership fees total paid $ ______

PCYC Applicant Background Information
Release Form

Palmer’s Cove Yacht Club, Inc. may elect to perform a background check as a condition of your applying for membership in the yacht club. A background check may include, and may not be limited to, confirmation of details in your application, character reference calls, and any other checks which may be necessary to determine eligibility for membership.

The information on the application, this page, and the resulting background check will be used exclusively by the PCYC Membership Committee and the Board of Directors to determine eligibility for membership in the yacht club.

Date
Name
Social Security Number*
Current Employer
Current Supervisor & Telephone Number
Previous Employer
Previous Supervisor & Telephone Number

*All information collected on this form and received as a result of any background check will be kept confidential in accordance with the Massachusetts Data Privacy Law. 201 CMR 17.00.

I hereby authorize PCYC to perform a background check on me.

Date______

Signature ______