Name                                                                                     Spouse                                                                    

Address                                                                                                 Apt / P.O. Box                                           

City                                                                                State                          Zip                    -                 

Phone:  Home (        )                                       Business (        )                               Fax (        )                   

Email Address                                                                          Occupation                                                           

Sailboat Make & Length                                                  Name                                       Reg. No.* PA                 

Dinghy Make                                                                   Name                                        Reg. No.* PA                  

Other Type                                                                      Name                                        Reg. No.* PA                 

.

GENERAL INFORMATION
For club information and membership possibilities, contact

George Henry, Membership Chairman

P.O. Box 155

Sandy Lake, PA 16145

Phone:  724-376-3281

• The initiation fee is $550.00 and must accompany this application. The fee is not returnable if you withdraw your application once the membership has met and approved the application. If you are not approved, the fee will be returned.

• Make your check payable to "Pymatuning Century Club" and mail it with the application to Sue Boyle, Secretary/Treasurer, 2024 S. Broadway, Geneva, OH 44234.

• Dues, mooring fees, etc. are due within 30 days of your acceptance. If during the off season, the date is March 1.

• Moorings and dock spaces are assigned by the Harbor Master. Only smaller boats (usually under 19 feet) can be assigned dock space. Lockers are assigned by the Secretary.

• Members must carry liability insurance on their boat either as part of their homeowners policy or a separate policy.

• Under the terms of our lease with the State of Pennsylvania, our Club is required to issue and collect fees for the State Mooring Decals for all offshore, shoreline, on-shore and trailer moorings. All boats (sail, dinghy, canoe, inflatable, boards, or anything else that floats) left overnight, must have a decal. You will not be able to purchase them at the park office or through the mail. Decals will be distributed at the Spring Work Party or mailed.

• If your boat is waterborne on Pennsylvania waters more than on waters of another state, it must be registered in Pennsylvania regardless of where you live.

• The sponsorship of two (2) current members is required on this application. By their signing of this application, they agree that they will properly introduce you to the Club constitution and by-laws, and all the rules and regulations.

Sponsor #1                                                  Sponsor #2                                           

If accepted as a member of the Pymatuning Century Club, I agree to abide by the constitution and by-laws and all rules and policies of the Club with regard to its use, enjoyment and the timely payment of any applicable fees.

I desire to become a member of the Pymatuning Century Club:

Signature                                                          Date                             

* * * * * TO BE COMPLETED BY THE CLUB * * * * *

Date Received                        Check No.                           Amount $                    

Action:  Approved                     Disapproved                    Date                         Revised 1/23/10