Music City Powerboat Association A Non-Profit Corporation - Hendersonville, TN MCPA Membership Application (May 1, 2010 - May 1, 2011) Please Print Name:___________________________________ First Mate Name: __________________________ Address: _____________________________________________________________ City, State, Zip:_________________________________________________________ Home Phone:________________________________ Work Phone:_________________________________ Cell Phone:__________________________________ E-Mail Address:____________________________________________________________ Boat Year:________________ Make:_____________________ Model:_____________________ Length:____________ Offshore Only Screen Name (if applicable):________________________________________________ TWRA Registration: ____________________________________________ Number & Expiration:_____________________________________________ Name of Vessel & Port of Call (if applicable): _________________________________________________________ Boat Insurance Provider & Expiration Date:___________________________________________________________ Proof of Insurance: (circle) No or Yes Will provide within 10 days NOTE: All of the above information will be held private with the Board of Directors of the MCPA and not released to any other person(s) or entity. Phone numbers, e-mail and home addresses will be available to Full and Social Members ONLY with your approval. Initial:__________________ Indicate the type of membership you are applying for. Enclose form with payment for the amount shown below (all checks must be made payable to Music City Powerboat Club or MCPA) and proof of insurance. Please mail to: MCPA 182 Cumberland Dr. Hendersonville, TN 37075 or... simply hand deliver to any Director of the Association. Applicants will be notified via mail, e-mail or fax of their status. Memberships are subject to the Articles of the Incorporation and the By-Laws of MCPA. There will be a $20.00 returned check fee. FULL MEMBERSHIP: Annual dues: $100.00 Benefits include access to all events 2 full membership ID cards, 2 dinner tickets for annual Christmas Party. Must be powerboat owner and 21 years of age. Signature:____________________________________________________ Date:________________________________ First Mate Signature:____________________________________________ Date:________________________________

Music City Powerboat Association

A Non-Profit Corporation - Hendersonville, TN

MCPA Membership Application

(May 1, 2010 - May 1, 2011)

Please Print

Name:___________________________________

First Mate Name: __________________________

Address: _____________________________________________________________

City, State, Zip:_________________________________________________________

Home Phone:________________________________ Work Phone:_________________________________

Cell Phone:__________________________________

E-Mail Address:____________________________________________________________

Boat Year:________________ Make:_____________________ Model:_____________________ Length:____________

Offshore Only Screen Name (if applicable):________________________________________________

TWRA Registration: ____________________________________________

Number & Expiration:_____________________________________________

Name of Vessel & Port of Call (if applicable): _________________________________________________________ Boat Insurance Provider & Expiration Date:___________________________________________________________ Proof of Insurance: (circle) No or Yes Will provide within 10 days

NOTE: All of the above information will be held private with the Board of Directors of the MCPA and not released to any other person(s) or entity. Phone numbers, e-mail and home addresses will be available to Full and Social Members ONLY with your approval.

Initial:__________________

Indicate the type of membership you are applying for. Enclose form with payment for the amount shown below

(all checks must be made payable to Music City Powerboat Club or MCPA) and proof of insurance.

Please mail to:

MCPA

182 Cumberland Dr.

Hendersonville, TN 37075

or... simply hand deliver to any Director of the Association. Applicants will be notified via mail, e-mail or fax of their status. Memberships are subject to the Articles of the Incorporation and the By-Laws of MCPA. There will be a $20.00 returned check fee.

FULL MEMBERSHIP:

Annual dues: $100.00 Benefits include access to all events

2 full membership ID cards, 2 dinner tickets for annual Christmas Party. Must be powerboat owner and 21 years of age.

Signature:____________________________________________________ Date:________________________________

First Mate Signature:____________________________________________ Date:_________________________________