In completing this application, the undersigned applicant indicates he is an enthusiastic fisherman; he is willing to participate in the club’s activities, by voice and in his presence; and agrees to attend at least four meetings per year and FISH at least two times per year in club tournaments or outings to maintain his/her membership. NCA Picnic & Banquet do not count as outings. Guides are exempt. 7/15/08

If paying by check - make it out to CASH or Randy Darr

Name:__________________________________ Telephone:________________________

Mailing Address: ___________________________City: _________________Zip:_______

Spouse’s Name: _______________E-Mail Address:________________________________

Do you have a VHF radio? Yes ( ) No ( ) VHF Call Name:___________________________

Do you have a boat? Yes ( ) No ( ) Manufacture & Length__________________________

Do you have a trailer? Yes ( ) No ( ) Do you typically trailer your boat? Yes ( ) No ( )

Sponsor’s Signature if you are a non-boat owner:_______________________________

Are you a permanent Florida resident living in the state 12 months per year? Yes ( ) No ( )

I have lived in this area _________ years.

Are you willing to serve an appointment to a committee? Yes ( ) No ( )

How often do you typically fish per month (average)?_______________

Do you have boating experience in these local waters or within 50 miles of this location? Please tell us briefly what areas you have experience in:

Do you have a valid Florida fishing license? Yes ( ) No ( )

Do you have your own fishing tackle: rods, reels, etc.? Yes ( ) No ( )

Please tell us about your fishing experiences. Locations usually fished (state, area, etc.). Species preferred to fish for: freshwater/saltwater. Preferred equipment: fly-fishing, spin casting, bait casting, etc

Are you 21 years of age or older? Yes ( ) No ( )

$20.00 annual dues paid will be refunded if the Executive Committee does not accept membership, or if membership is rejected by applicant upon receipt of a copy of the Club By-Laws and Policies and Procedures.

Date Approved:_____________