PEQUONNOCK YACHT CLUB AUXILIARY APPLICATION
 
DATE: _____________________________________________________________

NAME: ____________________________________________________________

ADDRESS: __________________________________________________________

CITY, STATE, ZIP: _____________________________________________________

HOME PHONE: ______________________________________________________

CELL PHONE: ________________________________________________________

EMAIL ADDRESS: ____________________________________________________

BIRTH DATE, YEAR NOT REQ’D, MUST BE OVER 18: _________________________
 
SPONSOR MEMBER’S NAME: __________________________________________

MEMBER’S ELECTION DATE: ___________________________________________

RELATIONSHIP TO MEMBER: ___________________________________________

MEMBER’S SIGNATURE: ______________________________________
 
DUES PAID - $25: ____________________________________________________
 
​Please print and submit at club or office or save as PDF and email to address below.
 
Contact:   PYCAux@Yahoo.com