Name___________________________________________________________ 

Address_________________________________________________________ 

City____________________________________ State______ Zip___________

Email Address____________________________________________________ 

Home Phone_____________________  Cell Phone________________________

Spouse's Name____________________________________________________ 

AMYA Member ? Yes__ No__      AMYA Member #__________________________ 

Class of boats owned________________________________________________ 

_______________________________________________________________ 

  First Time Members_$30.00   Pd_(__)    Covers first two years dues

  Fees received by______________ 

In consideration of accepting my membership, I hereby for myself, my heirs, executors and administrators waive and

release any and all rights to claim damages that I may have or acquire against the South Daytona Model Yacht Club(s),

its members, the sailing site owners, employees, agents, representatives, or assigns from any claim for injury or other

damages to me or my family during any and all club events.

Date____________ Applicant's Signature_________________________________________

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