N.S.A. MEMBERSHIP APPLICATION 2012

Member Information

Last Name
First Name
Co-Member
Street Address
City
State
Zip
Home Phone
(area code first)
Mobile Phone
(area code first)
Do you want your
mobile published?
yes no
Emergency Contact
Person
Emergency Contact
Persons Phone
EMail Address
(required)
Members Occupation
Work Phone
Co-Members Occupation
Work Phone
1st Names of
children under 23:



Birthday
(Mo/Day/Yr)



Gender
(select)




Boat and Storage Information

Class of Boat
(make/length)
Boat 1 Boat 2 Boat 3
Boat Name
Boat 1 Boat 2 Boat 3
Registration Number
(absolutely required)
Boat 1 Boat 2 Boat 3
Mooring
Boat 1 Boat 2 Boat 3
Wet Slip
Boat 1 Boat 2 Boat 3
Storage Space in Yard
Boat 1 Boat 2 Boat 3
Does Slip Transfer Apply?
(must have letter from member selling boat)
Boat 1Y N Boat 2Y N Boat 3Y N
Please indicate if you wish to be assigned to a committe for work credit, work credit is $10/hr to a maximum of 16 hours. Credit will be applied to the next year's dues. Yes No.
(You must work a minimum of 8 hours to continue to be eligible the following year in the work credit program.)
If you marked "yes", indicate your committee preference by making selections in the drop list of available committees.
My first Work Committee choice:
My second Work Committee choice:
My third Work Committee choice:
Any special skills you have which would greatly benefit a committee should be detailed here:

Note: Preferences in no way will guarantee placement on that committee. Committee assignments are determined by the Commodore Elect according to individual committee needs, budget restraints and the number of current members already assigned.

DUES / FEES 2012

Ninnescah Sailing Association
P.O.Box 1587
Wichita, Kansas 67201
Email: administrativesecretary@ninnescah.org 		Administrative Secretary
Allen Johnson
Boat: Wild Hare, slip A-20
Fax & Phone (316) 729-5757

Member NameDate$:
Initiation Fee for new members is $107.30 (includes 7.3% tax)$:
Annual Dues for Active Member is ($380.00 + 7.3% tax) $407.74
Discounted in half after August 1)		$:
Junior Member (must be under 23)
Date of Birth is $26.83		$:

Club Storage:

    Yard spaces, moorings, and wet slips (see note #1 below).
    Totals must agree with spaces indicated on "Boat and Storage" section of form.
    All the items listed below are prorated for the season.
    Please contact the Administrative Secretary for current prorated rates.

10' Wide Yard Spaces
needed		each space at $157.50 ea. =$:
12' Wide Yard Spaces
needed		each space at $212.50 ea. =$:
15' Wide Yard Spaces
needed		each space at $237.50 ea. =$:
Moorings neededeach space at $227.50 ea. =$:
Wet Slip (if available)$455-$820 based on slip
see slip info where you access this form		$:
Crane Access Fee$50 (req'd if you intend to use the NSA crane)$:
TOTAL AMOUNT DUE$:
NOTES:

1: Club storage space is limited. All club storage is asigned based on availability in accordance with the club rules and by-laws. Submission of this membership application and payment of dues and fees does not guarantee any space assignments. Questions concerning the availability of club space should be directed to the club's administrative secretary prior to the submission of membership application. Inquiries should be sent to the PO Box address listed above or call (316) 729-5757.

2: Payments, contributions or gifts to Ninnescah Sailing Association, Inc. are not tax deductible as charitable contributions.

3: You must complete the information on this form, otherwise the application will be returned. This especially applies to registration numbers, which are necessary for club records.

4: NSA requires proof of liability insurance for any boat located on NSA property or grounds. Please provide proof of insurance with your application. Also, a signed lease agreement is required. Download, print, sign and date the member lease agreement from this link and submit with this application.

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