Port Jefferson Yacht Club
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Member Information Form
Use this form to apply for new membership or to update your membership info.
Just want more info before applying? Click
HERE
for our contact form and select ‘Membership Info’ as the subject.
To apply for membership, fill out as many fields as possible.
To update your member info, just fill out the required fields, and any data that needs changing.
Purpose
*
New Membership Application
Update Existing Member Info
Membership Level
*
Launch - With Boat
Non-Launch + Slip
Non-Launch - With Boat
Special - Canoe/Kayak/PaddleBoard/Other
Name
*
First
Last
Spouse/Partner Name
First
Last
Mailing Address
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Address Line 2
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State
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Email
*
Spouse/Partner Email
Primary Phone
*
Home or Cell
Work Phone
Cell
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Occupation
Spouse/Partner Occupation
Boat Type(s)
Power
Sail
Paddle
None
Select all that apply. Ctrl-click to select multiples.
Boat Name(s)
Boat Make(s)
Length Over All for each boat
Sail Number
If applicable
PHRF Rating
If Applicable and Known
Rig Type
If applicable. Such as 'Sloop', 'Yawl', etc...
Engine - Primary Boat
Outboard
Inboard
I/O
N/A or None
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Fuel - All that apply to all boats
Gas
Diesel
Electric
Other or N/A
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Children - Names/Ages
Skills/Interests/Talents
Areas you might volunteer for
Social
Education/School
Racing
Cruising
House/Grounds
Docks
Launches/Moorings
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