BURNIN’ WATER SKI CLUB

Membership Application

Each individual is encouraged to be an active USA Water Ski member.  Please complete the following membership application and return this form along with your club fees to Burnin’ Water Ski Club, Box 9400, Chapel Hill, NC 27515.  Fax (919) 933-9412 

Individual/Head of Household____________________________Social Security#_________­­­­­_______-----_________ 

Street Address __________________________________________________________________________________   

City_______________________________________State________________________Zip Code_________________ 

Day Telephone __________________  Night  Telephone__________________  Lake Telephone___________________    

Fax_______________________  E-Mail address________________________________________________________ 

Club Membership Fees           

q    Individual Membership -  $ 20.00                

q    Family Membership - $ 50.00                                             

 

Family Members 

            Name                                                               Social Security#                     Birthdate             Gender     

 1.____________________________    __________________   _________    ______

 2.____________________________    __________________   _________    ______

 3.____________________________    __________________   _________    ______

 4. ________________________________      ____________________    __________      _______ 

 5. ________________________________       ____________________    __________     _______ 

 

_______________________________________________       ___________________

     Head of Household Signature                                                           Date

( A parent must sign for members who are 17 and under)