Name: _________________________________________________________________________________________
Address: _______________________________________________________________________________________
City:__________________________
County:______________________ State:_____________ Zip:___________________
Home Phone:___________________Work Phone:___________________Cell Phone:___________________
E-mail:_______________________________________Web Site:______________________________________________
Spouse Name:__________________________
Children _______________________ Pet’s
Name _____________________
Type of Annual Membership Requested (check one)
c Individual
$30 c Family $50 c Other $_________
I would like to make an additional donation
of $ ______________________
I am (check as
many as apply)
c a boater c a fisherman c a waterfront
property owner c a guide c a charter boat captain
c a marine
industry businessman c a membership
organization c a property
developer c a realtor
c a yacht club c a government department c an insurance company c an engineering
company
c a member of a
cruise club or yacht club ( Name of club ________________________________
)
c Other_________________________
I would like to sign up and volunteer:
c to
participate in a sandbar clean up c
to help organize fund raisers c to participate in
fund raiser cruises
c to attend
public meetings (F.W.C,
D.E.P, County, etc. ) c to offer professional services
Make checks payable to:
Save Our Sandbar Inc. 4542 Trouble Creek
Rd. New Port Richey, Fl. 34653
By applying for membership,I am agreeing
to support the actions of the Save Our Sandbar Board of
Directors and will adhere to decisions made by them.
Signature_____________________________________
Date:______________________
