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Name________________________________________ Street______________________________________ City, State, ZIP________________________________________ Phone_______________________________________ Second address (summer address): Street______________________________________ City, State, ZIP_________________________________________ Phone_______________________________________ Email_______________________________________ Family members:__________________________________________________________________ Beetle Cat Owners please provide information on your boat: Boat Name_________________________________ Hull number_________________________ Sailnumber__________________________ Home port___________________________ Year first launched (if known)_____________ Yacht Club affiliation (if any)____________________________________ Please check one: ( ) Individual membership $10 ( ) Family Membership $15 ( ) Contributing Membership $25 Please make check payable to NEBCBA and mail along with this form to: Sueanne Bouchie, Treasurer PO Box 1102 North Falmouth, MA 02556