Your Name:

______________________________________________________________________

Name of Business:

______________________________________________________________________

Business Address:

______________________________________________________________________

City:_________________________

State:

_____

Zip:

_______

Phone:_____________________             Fax:_____________________

Website:_____________________             Email address:_____________________

Class of Membership Desired:

Brokerage Business

___

Broker

___

Associate

___

Briefly state your reason for desiring membership in GCYBA:

________________________________________________________________________________

________________________________________________________________________________

Recent marine employment history, including positions held:

________________________________________________________________________________

________________________________________________________________________________

Business references (2) including telephone numbers:

_____________________________________________

Phone:

_______________

_____________________________________________

Phone:

_______________

Sponsored by two active members:

Signature

____________________

Signature

____________________

If elected to membership in the Gulf Coast Yacht Brokers Association,
I agree to abide by and conform to the Constitution, By Laws and policies of the Association.

Dates:

__________

Applicant's Signature:

_______________________

1 year $75 (Broker)

1 year $150 (House/Brokerage)

House must include pictures of location.

1 year $150 (Associate)

Enclosed Check No.

__________

Mail to: Gulf Coast Brokers Association, PO. Box 263, Seabrook, Texas 77586