(PLEASE PRINT)

Application for Membership: 20____ Sponsor Name: _____________________________________________

Name:

/
First

Last

Birthday mm/dd

Last

Birthday mm/dd

Name:

/
First

Street:
City:

State:

Telephone:

Zip Code:

Home

Email 1:

Cell 1

Cell 2

Email 2:

Name of Boat:
Place of Moorage:
Size of Boat: Length

Width

Please check one:

Dues First Year - $125

Renewal - $100

Do you authorize Illinois Cruisers Yacht Club the use of photographs taken of you, your guests, and your boat
for website photo gallery located at ICYCIL.com
Yes
No
Please do not use ICYC Members information for solicitations. Thank you.
__________________________________________________________________________________________
Signature of Applicant
Date
Please forward the application and dues to the Treasurer of Illinois Cruisers Yacht Club (ICYC).
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------TO BE COMPLETED BY ICYC:
ALL NEW MEMBERSHIP APPLICATIONS MUST BE PRESENTED TO THE MEMBERS OF ICYC FOR APPROVAL AND MEMBERSHIP LIST UPDATED.

__________________________________________________

________________________________________

APPROVED BY: BOARD OF DIRECTORS

MEMBERSHIP #

DATE

___________________________

DATE BURGEE ISSUED _______________

Revised 10-27-2013