LAKE MEAD BOAT OWNER ASSOCIATION
Membership Application
NAME(S):_________________________________
Birth Date:_________________________________(Month/Day)
Birth Date:_________________________________(Month/Day)
(If Family Membership, names of both adults)
______________________________________________________________
______________________________________________________________
ADDRESS:_____________________________________________________
City/State:____________________________________ Zip:___________
Home Phone:________________________________________________
(Work, if applicable)__________________________________________
(Cell Phone)__________________________________
(E-mail Address)______________________________
Signature______________________________________Date:__________
Check to LMBOA enclosed in the amount of $________
* * * * * *Please Fill Out Below, if applicable* * * * * *
Name of Boat::
Type (Make and Length):
Where is your Boat located?
VFH Marine Radio Equipped? Yes No
Special Interests/Comments:
Membership Dues:
(Effective July 1 2002 thru June 30, 2003)
Individual Membership: $20 per year NOTE: ($10 if you join after December 31)
Family Membership: $30 per year NOTE: ($15 if you join after December 31)
Upon completion of membership application, please mail to:
Lake Mead Boat Owners Association
P.O. Box 60833
Las Vegas, NV 89160
