Affiliate Membership Application
Name (Last, First, Middle Initial)
Street Address
City, State, Zip
Primary Phone
Summer Phone
Cell/Pager No.
Boat Name
Marina
Boat Make, Length, Year
USCG License No., Issue Date
Web Address (If you would like a website for your business, please type "Need a Website" in the box
Email Address
Basin(s) you fish Western Central Both
Do you own or operate an Inspected Vessel ( T-Boat operator ) Yes No
Select a Username for this site (e.g. Boat Name)
Select a Password for this site (min 6 characters)
Re-Type Password
 
Charter Boat Association ( you are a current member of )
   
   

Please make sure every box is FILLED IN. Place an N/A in the boxes that do not apply to you. Incomplete forms will be rejected and thus prolong getting your membership active!