Membership dues are $ 15.00 and expire December 31, 1999

Member’s Name:

Member’s Name:

Crew / Family Members:

Home Phone:

Member’s Business Phone:

Member’s Business Phone:

Member’s E-Mail Address:

Address (street):

(city, state, zip code):

Catalina (model): Model Year: 19

Boat Name:

Yacht Clubs(s):

Marina:

Location:

Dock Number: LECOA Member Since (year):

Please make check/money order payable to:

(signature)

LECOA: Ken Marshall, Treasurer

Please mail application and dues to:

(date)

Rosie Daniels