ACBS & FLC MEMBERSHIP APPLICATION

Name(s) _______________________________________

Address _______________________________________

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 for ACBS $5 for FLC. Junior Life (JL) $500.

For individuals, their spouses/partners and any children under 21:

Annual Adult (AN) for acbs $35 for flc. $20. 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