Membership Application

Please use the following form to submit a new member application. Since we are an all electronic Club (no snail mail) you are requested to provide a User Id (your email address) and assign a password. Please use the email for the primary contact member who we need to communicate with.

User Id*

E-mail Address*

Password*

Confirm Password*

First Name

Cell Phone

Badge Name

Last Name

Birth Day

Safety Class

First Name 2

Cell Phone 2

Badge Name 2

Last Name 2

Birth Day 2

Safety Class 2

E-Mail 2 Address

Home Address

Boat Name

Make and Model

Length

Elec. power

Beam

Draft

Boat Type

IMPORTANT: You must be a member of the PGI Civic Association and not be a member of another PGICA Boat Club to join the PGISLANDERS CRUISING CLUB. AMOUNTS DUE ARE:

Annual Dues ($15.00/person),
Club Burgee ($35.00)
Name Tags ($15.00/person)
_____________________
Total Amount for 2 persons is $95.00

Thank You,

Robin Herrick
Membership Director
2240 Deborah Drive
Punta Gorda, FL 33950

Only fill in if you are not human