Eglin Yacht Club Membership Application 
This form should be filled out then printed and brought to the Eglin Yacht Club

Member Information
First Name: Last Name:

 Spouse's Name:              Do you have internet access? Yes   No

Address:

City: State: Zip Code:

Your Birth Date (DD/MM): Your Spouse's Birth Date (DD/MM):

Home Phone: Work Phone: Rank/Grade:

Email Address:

Boating Information
Boat Name: Type: Size:
Make/Model:    Registration Number:

Date of Application

Your Status:  Military Civil Service Contractor ---and you are---Active Retired Widowed

Are you willing to release the above information to other members of the club? Yes No
Dive Information

Date of Certification:

Type of Certification:

Certifying Organization:

Registration on NR:

Date of Last Physical:

Instructor NR:

Authentication By:

Date of Authentication:

 Please Note
The Eglin Yacht Club is a social organization run by volunteer member's manpower. When you join, you and your spouse will be expected to volunteer your time for one of the duties listed below. Please check each of the following that you would desire to serve:
 Bartender

Hamburger night cooking crew chief

Hamburger night crew helper

Dive equipment rental duty     

Membership dinner crew chief

Membership dinner crew helper

Club self help projects

Wash dishes/meal cleaning

Other tasks as needed

Please list any self-help expertise you have, i.e., plumbing, carpentry, painting, electrical, design/layout, etc.

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