Membership Application
Mailing Address:
1901 Brinson Road, M5
Lutz, Florida 33558
Email to:
Secretary, Jane Gamble
markandjaneg@verizon.net
Name_____________________________________________________________________________________
Address:__________________________________________________________________________________
Home Phone:________________________________ Cell:__________________________________
E-mail Address_____________________________________________________________________________
Diving Qualification(s):_____________________________________________________________________
Boating Qualification(s):____________________________________________________________________
Are You Willing to Serve on a Committee? Yes No
Do you Own a Boat? Yes No
Emergency Notification: Name________________________________________________________________
Address:__________________________________________________________________________________
Phone Number________________________________ Relationship:_________________________________
Check Payable to The Nautical Nudist Club for $25 couple, $15.00 single.
OFFICE USE ONLY
Date of Expiration:________________________Membership Number:_______________________________
Come and Join the Fun!!!
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