Membership Application/Invoice
Name_______________________________________________ Spouse________________________________________________
Month of Birth_________________________________________ Month of Birth___________________________________________
Street Address _______________________________________________________________________________________________
City ________________________________________________ State _______________________ Zip Code___________________
Home Phone__________________________ Work Phone_________________________ Cellular Phone_______________________
Spouse Work Phone ____________________________________ Spouse Cellular Phone___________________________________
Home e-mail___________________________________________ Work e-mail___________________________________________
Spouse Home e-mail____________________________________ Spouse Work e-mail ____________________________________
Name and Age of Dependent Children Living with you:_______________________________________________________________
Boat Name__________________________________________________________________________________________________
Manufacturer______________________________________Model __________________ _Year_____________Length___________
What is your main reason for wanting to join the Lake Palestine Yacht Club? _____________________________________________
____________________________________________________________________________________________________________
Are you willing to participate in club activities, including work parties, committee functions, and social events?_________________
Committee Interests:
Rules_________ Communications__________Social___________Membership_____________Other_________________________
What other club activities would most interest you?__________________________________________________________________
Recommended By: 1. ________________________________________ 2._______________________________________________
(Requires Signature Of Two Members In Good Standing)
Note: The above information is compiled for club membership only. If you do not want your home/work/cellular telephone number(s),
home/work e-mail address(es) to be published in the directory, please cross out those features in this paragraph or simply do not fill
in the blanks. We do not share our database information, other than with members. Also, if you do not want to be included on club
member only e-mailings, please check here ___________
I wish to apply for membership in the LPYC and acknowledge that I will support the club in its endeavors and uphold all by-laws
voted and approved by the membership. I hereby release LPYC, its officers and directors from any and all losses liabilities and
damages that might be suffered bymyself, my family, my guests and or boat during any LPYC sponsored events.
Signature_____________________________________________________________ Date _______________________________
Please send your completed application and check to John Springer LPYC Treasurer, 6501 Glen Eagles Dr., Tyler, TX, 75703. Telephone 903-218-1225 E-mail inquiries
may be addressed to:
Dues: $100 per family per year for new members. Upon receipt of form and fees, applicant enjoys the privileges of membership, but membership is contingent on being approved at the next meeting of the Board of Directors.