DAY ISLAND YACHT CLUB

COURTESY ENTRY PERMIT

This permit must be completed, top and bottom copies, by the authorizing DIYC member.

Name: ____________________________________________________________________________

                                    (Please print name of person to whom you are authorizing entry)

Representing: ______________________________________________________________________

                                    (Please print company business name)

Company Phone Number: ____________________________________________________________

Purpose of Entry: ___________________________________________________________________

Date Entry Authorized: ___________________   Date Entry Expires: ___________________

Gate Card Serial Number: _________________________

Club Member’s Name: _______________________________________________________________

Club Member’s Signature: ____________________________________________________________

Date Signed by Member: ____________________________________________________________

----------------------------------- Bottom Copy Entry Permit ----------------------------------

Name: ____________________________________________________________________________

                                    (Please print name of person to whom you are authorizing entry)

Representing: ______________________________________________________________________

                                    (Please print company business name)

Company Phone Number: ____________________________________________________________

Purpose of Entry: ___________________________________________________________________

Date Entry Authorized: ______________________    Date Entry Expires: _____________________

Gate Card Serial Number: __________________________

Club Member’s Name: _______________________________________________________________

Club Member’s Signature: ____________________________________________________________

Date Signed by Member: ____________________________________________________________

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Revised: 7/8/2006