Experience Buffalo Yacht Club

Membership Type o Active (Ages 21+)

o Intermediate (Ages 24-39)

o Social

Applicant Information Name Title First

MI

Last

Nickname

Primary Address

Street

City

State

Zip Code

Alternate Address

Street

City

State

Zip Code

Primary Email Address

Date of Birth

Mobile Telephone Number

Home Telephone Number

Is it okay to publish your email in the roster? o Yes o No

Is it okay to publish your phone number(s) in the roster? o Yes o No

o Single

o Married

o Significant Other

o Widowed

Anniversary Date

Spouse / Significant Other Information Name Title First MI

Last

Nickname

Primary Email Address

Date of Birth

Mobile Telephone Number

Home Telephone Number

Is it okay to publish your email in the roster? o Yes o No

Is it okay to publish your phone number(s) in the roster? o Yes o No

Boat Information #1 Boat Name

Builder

o Sail o Power

LOA

Beam

Draft

I wish to apply for a slip at o Buffalo o Pt. Abino

Are you the sole owner? o Yes o No

Boat Information #2 Boat Name

Builder

o Sail o Power

LOA

Beam

Draft

I wish to apply for a slip at o Buffalo o Pt. Abino

Are you the sole owner? o Yes o No