Potomac Boat Club    3530 Water Street, N.W., Washington, D.C. 20007

MEMBERSHIP APPLICATION

Please complete and return this application with a non-refundable $50.00 application fee to the above address: Attn: Membership committee.

PERSONAL DATA

Name: __________________________________	Spouse: _________________________
Home Address: ________________________________	Apt: _______
City: _______________________ State: _______	Zip: _______
Mailing address (if different): ________________________________	Apt: _______
City: _______________________ State: _______	Zip: _______
Telephone: (H) (_____) ____________________	(O) (_____) ____________________
	Fax (_____) ____________________
E-mail address: __________________________________________________
Date of Birth (mm/dd/yy): _____/_____/_____	Gender: M _____ F _____
Employer: _______________________________________
Work Address: ___________________________________
City: _______________________ State: _______	Zip: _______

TYPE OF MEMBERSHIP

Senior ________ Junior ________ Guest ________ Program ________

PROGRAM PARTICIPATION

Do you know how to row? Yes: _____ No: _____
Recreational:
Novice _____	Intermediate _____	Advanced _____
Competitive:
Heavyweight _____	Lightweight _____	Sweep _____	Sculling _____
Masters _____	Lightweight _____	Women _____	Junior _____

If you are currently participating in an official (PBC) Club program, please provide DATE and AMOUNT OF DUES PAID:

Date: _____/_____/_____       Dues: $__________

Name of Coach: ________________________________

ROWING EXPERIENCE

Please describe your rowing and program experience, including high school, college, and club:

List any instructional programs you have participated in:

Present and previous boat club affiliation (including dates):

US Rowing Association number: __________

WORK SKILLS

Please list any work skills you would be willing to contribute to the Club's operation and maintenance (a minimum of 10 hours per year is required of each member):

REFERENCES

Club member, employer, coach, officer at your present or previous boat club. List at least two with phone numbers.

This contract must be signed and dated, or the application will be considered incomplete and therefore, void.

I agree to abide by Club constitution and other club rules and regulations. I will contribute at least ten hours of work a year to the management, maintenance, or repair of the club facilities and equipment. I agree not to use the Club or its equipment while on the waiting list unless expressly authorized by the Board of Governors. I will honor all financial obligations due the Club and understand that the Club may hold and sell for its account any property which I have at the Boat House for non-payment of dues. Dues are currently $400.00 a year payable on a semi-annual basis.

SIGNED: ______________________________     DATE: _____/_____/_____

Return to the Membership Information page.

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