DEEP CREEK CHARTERBOAT ASSOCIATION

PO Box 39423, Ninilchik, AK. 99639

GENERAL MEMBERSHIP APPLICATION

General Membership Annual Dues $100.00

Hired Captains Annual Dues           $  75.00

Crew Members Annual Dues           $  50.00

NAME: (First) ______________________  (Last) ______________________________________

MAILING ADDRESS: (This is the address to which all DCCA mailings (postal and email) will be sent)

Address:_______________________City:__________________State:_______Zip:___________

Phone:_______________________________     Fax:____________________________________

Email:_______________________________________

BUSINESS NAME:_______________________________________________________________

Your Position:  Owner, Operator, Crew Member, etc:__________________________________

Address:_______________________City:__________________State:_______Zip:___________

Phone:_______________________________    Fax:_____________________________________

Cell:__________________________  Email:___________________________________________

Web Site:  ______________________________________________________________________

Vessel Name(s):__________________________________________________________________

USGC LICENSE NUMBER:_________________________

FULL NAME AS PRINTED ON LICENSE:__________________________________________

ISSUE NUMBER:____________________DATE OF EXPIRATION:_____________________

“I agree to adhere to the By Laws set down by the Deep Creek Charterboat Association and to all

Federal, State, and local regulations pertaining to our industry.”

Signature:___________________________________   Date:__________________