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Name_______________________________Spouse____________

Family members________________________________________

Address_______________________________________________

City____________________________________St____Zip_______

ph:_____________________CELL PH#_______________________

Email____________________Sponsor________________________

1. What type of fishing do you do? Creek____Surf Fishing____                                                        

 In-Shore____Off-Shore____ Pier____Charter Boat____Head Boat____

2. Do you own a boat? Yes___No___

What is the name of your boat?_________________________

Type of boat?_____________Call Sign?__________________

3. Have you ever belonged to a fishing club? Yes___No___

4. I will be able to serve on the following committees:                                                  Tournament__Nomination__Dinner__Facilties__Clean-up__ Hospitality__Audit__Membership__Programs__

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Mail address: Seacoast Anglers Association

PO Box 510 • North Myrtle Beach, SC • 29597

EMAIL: SeacoastAnglers@aol.com  Web: www.seacoastanglersassociation.com

Meetings: 2nd Monday of each month at 6:30 PM.

Place: THE PARK at Long Bay, Hwy 9, Longs, SC (clubhouse)

Membership Dues $40.00 - New members July 1 to December 31 $20.00 per family

Amount Paid $__________Date______________Rec. By__________