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Marina Application

Full Name: Date of Birth: Last 4 Digits of SS# Address: City, State & Zip: Primary Phone #: Email Confirm Email Drivers License/State ID#: Expiration Date: Spouse/Co-Owner Full Name: Address: City, State & Zip Code: Phone #: Email Confirm Email If solely owned or if partnership, please provide partnership agreement. Yes No

Email Partnership agreement to: [email protected]

Emergency Contact: Relation: Address: City, State & Zip Code: Phone #: Name of Vessel: Displayed: Make/Model: Year: Length: Weight: Propulsion: Color: Beam: Draft: Fuel Tank Size: Engine Serial #: Hull ID #: DMR Registration # or USCG Doc #: State: Displayed: Certificate of Ownership: Insurance Company: Holder: Policy #:

Terms & Conditions: I understand that I cannot live aboard unless approved by the Marina Manager. Violation of this provision will result in termination of berth permit. Permittee acknowledges that there may be noise and or occasional inconveniences from surrounding business and special events. I have received and reviewed the Welcome Packet and agree to the terms and conditions noted on the full term of contract. By signing this application, I agree to follow the rules and regulations of the Marina as mandated by the Marina Ordinance.

Date: Please type your full name as your electronic signature (by typing your name below, you agree to the terms above.):

.st0{opacity:0.15;} Marina Application .st0{opacity:0.15;}

Marina Application