THE LOUISVILLE SAILING CLUB

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- Fill out the form and send it to:  Eugene Cox
                                     7210 Wood Briar Place
                                     Louisville, KY 40241 

    FULL NAME____________________________________  BIRTH DATE____ /____ /____
    ADDRESS__________________________________________________________________ 
    CITY_________________________________________  STATE______ ZIP:__________
    
    EMAIL ADDRESS________________________________  PHONE(H)__________________
    OCCUPATION___________________________________  PHONE(W)__________________ 
    SPOUSE'S NAME________________________________  BIRTH DATE____ /____ /____ 
    OCCUPATION___________________________________  PHONE(W)__________________
    CHILDREN:  NAME______________________________  BIRTH DATE____ /___ /_____
               NAME______________________________  BIRTH DATE____ /____ /____
    SAILING EXPERIENCE_______________________________________________________
    MEMBERSHIP APPLIED FOR:
         ____REGULAR   ___SENIOR  ____ASSOCIATE  ____JUNIOR  ____JR ASSOCIATE
    INTERESTED IN:   _______RACING    ________DAY SAILING     ________CREWING
    BOAT CLASS/BUILDER____________________________ SAIL NUMBER_______________
    BOAT CLASS/BUILDER____________________________ SAIL NUMBER_______________
    I HAVE READ THE BY-LAWS AND AGREE TO THEM.
    SIGNED________________________________________ DATED_____ / _____ / _____
    SECONDED BY_________________________ SECONDED BY_________________________
    LSC USE ONLY: MEMBERSHIP APPLIED FOR__________________________________
    INITIATION FEE_________  CURRENT YEAR DUES_________  DOCK FEE_________
    TOTAL AMOUNT DUE________  AMOUNT PAID________  DATED____ / ____ / ____