2017 LMCA Member Enrollment / Renewal form

Member Name*
You must enter your name.
Email Address*
Enter valid email address
First Mate Name
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First Mate Email Address
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Street Address*
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City, State Zip*
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Primary Phone Number (123-456-7890)*
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Boat Name
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Registration #
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Boat Make & Model
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Home Port
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Names & ages of children under 21
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Please check all boating interests
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Other interests
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Check all that apply*

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Please choose a payment method
Amount Due $0.00 USD