Columbia Yacht Club 2024 Membership Application

Page 1 of 9 - Name/address/employer

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Applying for which membership status

Applying for which membership status Regular Member Associate Member

I you have any direct or indirect beneficial interest in any Yacht, you need to apply for Regular membership.
Name Name First Middle Last
Gender

Gender Male Female
Primary Home Address Primary Home Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary contact phone number Primary contact phone number - ### - ### ####
Primary phone number type

Primary phone number type Mobile Home Work
Secondary contact phone number Secondary contact phone number - ### - ### ####
Secondary phone number type

Secondary phone number type Mobile Home Work
Email
Profession
Name of Business/Employer
Business Address Business Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Business Phone Business Phone - ### - ### ####
Business Email
Date of Birth Date of Birth / MM / DD YYYY
Marital Status

Marital Status Married Single

Spouses, domestic partners, and dependents under the age of 21 all share the same privileges of membership as the primary applicant.
Spouse Name (if applicable) Spouse Name (if applicable) First Middle Last
Spouse Date of Birth Spouse Date of Birth / MM / DD YYYY
Spouse Email
Spouse Cell Phone Spouse Cell Phone - ### - ### ####
Do you have dependents under the age of 21?

Do you have dependents under the age of 21? Yes No