Applicant Name: ________________________________________________________________

Lodge Membership Number: _____________________________________________________

Mailing Address: ________________________________________________________________

City, State, ZIP: ________________________________________________________________

Phone Number: _________________________________________________________________

E-Mail: ________________________________________________________________________

Signature: _____________________________________________________________________

Sponsored By (optional): _________________________________________________________

____________________________Official Use Only Below Line__________________________

Date of meeting voted in: ____/____/____            Seniority # ____________

Application Fee $10.00
Yearly Dues $20.00
Dock Assessment $___________

Paid $___________ (Check #________ or Cash)

Signature of Commodore or Vice Commodore

_______________________________________________      Date ____/____/____
(Rev. 10/26/08)

Must attend a Viking Boat Club Meeting and pay dues and application fee in full with
submission of application. All Viking Boat Club Meeting are held on the third
Wednesday of each month between March and September at 7:30 PM at the Lake Park.

Accepted

Yes      No