Membership Application/Invoice

Name_______________________________________________  Spouse________________________________________________

Month of Birth_________________________________________ Month of Birth___________________________________________

Street Address _______________________________________________________________________________________________

City ________________________________________________ State _______________________ Zip Code___________________

Home Phone__________________________ Work Phone_________________________ Cellular Phone_______________________

Spouse Work Phone ____________________________________ Spouse Cellular Phone___________________________________

Home e-mail___________________________________________ Work e-mail___________________________________________

Spouse Home e-mail____________________________________  Spouse Work e-mail ____________________________________

Name and Age of Dependent Children Living with you:_______________________________________________________________

Boat Name__________________________________________________________________________________________________

Manufacturer______________________________________Model __________________ _Year_____________Length___________

What is your main reason for wanting to join the Lake Palestine Yacht Club? _____________________________________________

____________________________________________________________________________________________________________

Are you willing to participate in club activities, including work parties, committee functions, and social events?_________________

Committee Interests:

Rules_________ Communications__________Social___________Membership_____________Other_________________________

What other club activities would most interest you?__________________________________________________________________

Recommended By: 1. ________________________________________ 2._______________________________________________

(Requires Signature Of Two Members In Good Standing)

Note: The above information is compiled for club membership only. If you do not want your home/work/cellular telephone number(s),

home/work e-mail address(es) to be published in the directory, please cross out those features in this paragraph or simply do not fill

in the blanks. We do not share our database information, other than with members. Also, if you do not want to be included on club

member only e-mailings, please check here ___________

I wish to apply for membership in the LPYC and acknowledge that I will support the club in its endeavors and uphold all by-laws

voted and approved by the membership. I hereby release LPYC, its officers and directors from any and all losses liabilities and

damages that might be suffered bymyself, my family, my guests and or boat during any LPYC sponsored events.

Signature_____________________________________________________________ Date _______________________________

Please send your completed application and check to.

Lake Palestine Yacht Club
6501 Glen Eagles Dr., Tyler, TX, 75703. 

Telephone 903-218-1225
E-mail inquiries may be addressed to: This email address is being protected from spambots. You need JavaScript enabled to view it.   Our web-site is: www.lpycboating.com

Dues: $100 per family per year for new members. Upon receipt of form and fees, applicant enjoys the privileges of membership, but membership is contingent on being approved at the next meeting of the Board of Directors.