City ______________________State/Prov. __________________________________
Postal Code ________________Country ____________________________________
Eve. Phone ____________________________________________________________
Day Phone ____________________________________________________________
E-mail Address _________________________________________________________
Dues
(in US $)
ACBS
FLC
For
individuals under age 21:
Annual
Junior (JM)
$15.
$5.
Junior
Life (JL) $500.
For
individuals, their spouses/partners
and
any children under 21:
Annual
Adult (AN)
$35.
$15.
Adult
life (LM) $750.
For
organizations (by business name):
Annual
Associate (AM) $100.
Associate
life (LA) $1500.
Type of ACBS Membership_________Dues $_________
Type of FLC Membership__________Dues $_________
Total Amount $_________
For
Junior Memberships, date of birth: ____/____/____
(At
age 21, Junior Memberships automatically become Adult Memberships.)
BOATS OWNED
Year ______ Builder _____________________________
Model ________________ LOA _____ Hull # ________
Engine Make ___________________ # Cyl. ____ HP ___
Boat
Name _____________________________________
(Please
list additional boats on a separate sheet.)
Send
this form and Total Amount to:
ACBS
Headquarters
422
James St.
Clayton,
NY 13624
Ph.: 315-686-2628
Fax: 315-686-2680
hqs@acbs.org