Day Island Yacht Club

Member Name: _____________________________________________ Date: ___________________________________

Address: __________________________________________________

 __________________________________________________

 Phone: (h)_________________________ (w)_________________________ (c)_________________________

 _______ Request for new moorage          _______ Request for change in moorage

Berth size requested: _____________________________________________

Listing deposit ($100.00)

Date paid: ___________________________________

Date Returned: ___________________________________

I have received a copy of the moorage rules.

Date: ___________________________________     Signed: ________________________________________

For Official use only:       Date application received: ___________________________________

By: _____________________________________________________

                                    Remarks: _______________________________________________________________