Name:
Address:
City: State: Zip:
Home Phone: Work Phone: Cell Phone:
E-mail: Birth Date:
Profession:
Do you have a CT State Boating license? Yes No LIC. # (see note #2 below)
Are you a Member of any other boating club? Yes No
If yes Please list:
Have you previously been a member of Connecticut Performance Boating Association (CPBA)? Yes No Date:
Reason for termination of membership?
Why do you wish to become a member of Connecticut Performance Boating Association?
Are you willing to work parties and participate in Club activities? Yes No
Do you have any special skills or talents that you think the club should know about?
REFERENCES:
List three people other then relatives and sponsors who have known you for at least 5 years.
(Include name, address, & phone number)
Junior members please have a parent or guardian print and sign name here, in lieu of references
1.)
2.)
3.)
SPONSORS: Two Members in good standing must sponsor you.
Name: Date:
APPLICATION:
1. This application must be accompanied by a non-refundable application fee/dues of $25.00.
(Checks made payable to Connecticut Performance Boating Association)
2. This application must have two (2) sponsors' signatures before it is accepted.
3. Application maybe submitted in person, email, or via regular mail. Payment can be made via PayPal, Check or Postal money order.
IMPORTANT NOTES:
If accepted for membership, I promise to abide by the provisions of the By-laws and all rules & regulations. I understand that the Connecticut Performance Boating Association is mainly made up of non-paid volunteers who work together to maintain the Club property and I will be asked to work at parties and participate in Club activities freely.
APPLICANTS SIGNATURE: DATE:
Connecticut Performance Boating Association
ATTN: Membership Secretary
322 Bushy Hill Road
Simsbury, CT 06070