| 2013 SOUTHERN KINGFISH ASSOCIATION MEMBERSHIP FORM | |||
| MEMBER INFORMATION Type your information on this web page and then print it out & fax it to us! | |||
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| New Member Renewal Member SKA Membership # | |||
| Name: | Nickname: | ||
| Address: | City: | ||
| State: | Zip: | ||
| Home # | Work # | x | |
| Mobile # | E-Mail: | ||
| DOB: | Please Note: A Social Security number is required for prizes of $600.00 or more. | ||
| MEMBERSHIP LEVEL – (CHECK ONE) | |||
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| Associate Member........... $40 | Professional Tour Captain's Membership Dues........ $140 | ||
| Competition Member....... $70 | Competition Renewal..... $65 | ||
| Competition Family**..... $90 | Competition Family Renewal**.......... $85 | ||
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Each primary member will receive 11 issues of our magazine - Angler - which is for SKA members only. **Family membership includes one Primary Member plus one family member. A Family Member is a Spouse/Partner or a Child who has not exceeded his 22nd birthday and still lives at home. Additional family members as defined are $30.00 each. |
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| ADDITIONAL FAMILY MEMBERS | |||
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| Name: | Name: | Add $30.00 | |
| D.O.B.: | D.O.B.: | ||
| Relation: | Relation: | ||
| Name: | Add $30.00 | Name: | Add $30.00 |
| D.O.B.: | D.O.B.: | ||
| Relation: | Relation: | ||
| PAYMENT INFORMATION-Membership Payment Method: | ||
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| Total (plus $30 per additional family member) $ | ||
| Check Enclosed Check Number | ||
| Visa Master Card American Express Discover (Include all Digits on Credit Card) | ||
| Card Number Expires Sec.Code | ||
| Print Name on Card: Signature: X_____________________________ | ||
| BOAT INFORMATION | |||
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| Boat Name: Make: Year: | |||
| Length: Power Mfg. by: # of Motors: Total HP: | |||
| Est. Hull Value: When did you purchase your vessel?: | |||
| Registration Number: Trailer Manufactured by: | |||
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Are you interested in receiving a complimentary quote from our partner and tournament sponsor NBOA? Yes No
Current Marine Insurance Provider:
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Return to: SKA, 15 Garnett Ave, St Augustine, FL 32084 Fax with Credit Card # to: 904-819-0331 |