Registration Test Page

Name
First Name*
Last Name*
Address*
Contact Info
Home Phone
Cell
E-mail*
Vessel Information
I / (We) are a boat owner
- Yes
- No
Name Of Vessel
Mfg. of Vessel
Length (in feet)
Marina
Create Your User Name and Password
Username*
Password*
Repeat Password*
Release and Indemnity
Nominated by:
I/we agree to authorize the above "Contact Information" to be posted on the DIYC Membership Contact List located in the DIYC Website (password protected) "Members Only" section.
- Yes
- No
I/we agree to authorize DIYC Director approved club photos (which may include your personal image) to be posted either on the DIYC website or DIYC display board located at the RiverHouse Pub and Marina.
- Yes
- No
My initials below certifies that I have read, fully understand and agree to the terms and conditions set out above and in the Deas Island Yacht Club "Release and Indemnity Form"
My initials*

Name
First Name*
Last Name*
Address*
Contact Info
Home Phone
Cell
E-mail*
Vessel Information
I / (We) are a boat owner
- Yes
- No
Name Of Vessel
Mfg. of Vessel
Length (in feet)
Marina
Create Your User Name and Password
Username*
Password*
Repeat Password*
Release and Indemnity
Nominated by:
I/we agree to authorize the above "Contact Information" to be posted on the DIYC Membership Contact List located in the DIYC Website (password protected) "Members Only" section.
- Yes
- No
I/we agree to authorize DIYC Director approved club photos (which may include your personal image) to be posted either on the DIYC website or DIYC display board located at the RiverHouse Pub and Marina.
- Yes
- No
My initials below certifies that I have read, fully understand and agree to the terms and conditions set out above and in the Deas Island Yacht Club "Release and Indemnity Form"
My initials*

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