DPBA Membership Application
Title:
First Name:
Spouse :
Last Name:
Address:
City:
State:
Zip:
(Zip + 4)
Home Tel:
Business Tel:
Cell Tel:
E-mail Address:
Alternate E-mail Address:
VESSEL INFORMATION
Boat Mfg:
Year:
Model:
LOA:
Boat Name:
Type:
Power
Sail
Self
Trailer:
Yes
No
Storage Location:
Marina:
East
West Side:
Island
Cove Slip Location:
Slip Size:
MEMBERSHIP TYPE
Mainsail Charter: $500.00 - Lifetime
Five Star Charter: $100.00 – Five Years
Twin Engine: $50.00 – Biannual
Waypoint: $25.00 Annual
Mate: $15.00 Annual
(21 and under)
Donation: $
(Please enter amount donated)
Total
: $
(Please calc membership fee plus any donation)
PAYMENT INFORMATION
Payment type :
Please Select
Check
Credit Card
If check , please send payment to :
Dana Pont Boaters Association
PO Box 461
Dana Point, CA, 92629-0461
Credit Card Info
Credit Card Number:
Expiration Date:
CVVC Code:
(3 digit code on back of Visa/MC) (4 digit code on front of AMEX)
Credit Card Billing Address
(if different than above)
:
Address:
City:
State:
Zip:
I CAN ASSIST THE DPBA IN THE FOLLOWING AREAS
Printing
Legal
Dock Walker
Marine Industry Contacts
Donations
Marine Engineering
Governmental Contacts
Data Entry
Public Financial Planning
Marine Law
Accounting
Architecture
Traffic Engineering
California Coastal Commission
Event Organizing
Press/Media
Analysis
Other:
HOW CAN THE DPBA ASSIST YOU?
Please describe ways we can assist :