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Apply for a Boat Safe Membership
Boat Safe Membership Application
Please note that all fields followed by an asterisk must be filled in.
Name*
Name*
Mailing Address (Street or P.O. Box)*
Mailing Address (Street or P.O. Box)*
City / State / Zip*
City / State / Zip*
Lake Hamilton Address / Boat Mooring Location (if applicable)
E-mail Address*
E-mail Address*
Home Phone*
Home Phone*
Business Phone
Cell Phone
Select Membership Level*
Select Membership Level*
Escort Package $69/yr
Fleet Package $99/yr
Admiral's Package $149/yr
Add Carefree Boating Program ($50)*
Add Carefree Boating Program ($50)*
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Yes
No
Credit Card Type*
Credit Card Type*
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Visa
MasterCard
Name (As it appears on card)*
Name (As it appears on card)*
Credit Card Number*
Credit Card Number*
Expiration Date*
Expiration Date*
3-digit Security Code*
3-digit Security Code*
I have read and agree to the terms of the membership agreement*
I have read and agree to the terms of the membership agreement*
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Yes
No
Please enter the word that you see below.
