Application for Membership – Northern Yacht Club

Name *

First

Last

Email *

(This will also be used as your login to the website)

Password *

Occupation *

Home Phone

Cell Phone

Address *

Address Line 1

Address Line 2

City

Province

Postal Code

Do you have a boat? *

Please enter at least 1 reference you may have and write a brief description about yourself and why you want to join our club.

Reference Name *

Email

Phone Number *

Tell us about yourself

Terms and Conditions *

Signature

Clear Signature