Got Em On Live Bait Club Membership Application

PO Box 6, Carolina Beach, NC 28428, www.got-em-on.com

$45.00 Annual Dues renewable each January 1st

_________ Cash _________Check# ___________

Check one:

____________ Renewal (current mailing address and sign below)

____________ Renewal with changes (change info and sign below)

____________ New (complete entire application and sign below)

Sponsoring member (new members only) ___________________________________________________________________

Name:  ______________________________________________________________________________________________

Address: _____________________________________________________________________________________________

City: ______________________________________________ State: ___________________________  Zip: _____________

Employer: ___________________________________________________ Home phone: _____________________________

E-mail: _________________________________________________ Marital Status _________________________________

Boat info: Manufacture and Length ________________________________________________________________________

Boat name:___________________________________________________________________________________________

Your children under 18 are included in your membership.

How do you want to receive newsletters or upcoming club events information?
(Please keep club informed of any changes in current addresses)

Mail _____________________ or E-mail ___________________________________________________________________

If you are willing to help on any comittees, please contact any board member and give them your name and number.

I certify that the above information is accurate.  I understand that if I am accepted for membership, it will be probationary for a
period of six months from the date of acceptance.  I pledge to uphold the rules and regulations of the organization and to make
every attem[t to improve the quality of our fishing environment and the reputation of the club.

Signature: _______________________________________________________________________Date _____/_____/_____