MEMBERSHIP APPLICATION
 (Please print out, complete, sign and mail with payment to:
Gig Harbor Sailing Club & School; P.O. Box 1218, Gig Harbor, Washingon 98335)

Applicant's Name (Print, First, Middle, Last) _____________________________________________________
Spouse (Print, First, Middle, Last)_______________________________________________________
Children’s Name(s) _____________________, _____________________, _____________________,
Age(s) ____________________________________
Street Address City State Zip _______________________________________________________________________________________
Mailing Address City State Zip _______________________________________________________________________________________
Home Phone ___________; Work Phone ____________; Email _____________
Drivers Lic. # ________________________ State _______; SS # ________/________/________
Business Address State Zip _______________________________________________________________________________________
How did you discover us? _______________________________________________________________________
Please provide a personal reference in case of an emergency. _________________________________________
Emergency Phone # _____________________________________

AUTOMATIC PAYMENT OPTION
* Automatically charge my dues: _______ (either monthly or annually)
* Automatically charge my annual insurance: ________
Initial in the spaces provided if you wish to select Automatic Payment Option.

Checking Debit: ___________________________________________________________
Bank Name: ______________________ Routing # ___________________ Acct. # ____________________________
Name on Card: ___________________ Signature: _______________________ Expiration Date: _____________

The following information is necessary for the purpose of extending credit:
VISA card # _________________________________________ Exp. Date: _______________________________
MASTER card # _____________________________________ Exp. Date: _______________________________

MEMBER SIGNATURE _____________________________ Date: _________

MEMBER SIGNATURE _____________________________ Date: _________

Gig Harbor Sailing Club & School: _______________________________________________

OFFICE USE
Date of membership ______ Insurance $___ $50. Yr. or ( $4.17 per month )
Type of membership ______ Total due $ _______________________________
Course fees $ ______ Total received $ _______________________________
Balance Due $ ______________________________________
Initiation fee $ ______ Payment Option CK. CA.