Membership Form
Mail to: CCSA, PO Box 893, Morehead City, NC 28557
(If renewing just print name, and any changes)

qNew            qRenew

Name:______________________________________________________________
(Enter spouse’s name if joining as a family membership or
Business name along with your name if joining as an advertiser)

Address:___________________________________________________________

City:________________________________State:__________Zip:_____________

Home Phone: ____________________ Work Phone: ________________________

Cell Phone: ____________________ Boat Name: __________________________

E-mail Address (optional)______________________________________________

 q Single - $30.00
q Family - $35.00
q Advertiser - $100.00  Include a new business card.
q Advertiser/Family - $105.00
q Newsletter only - $15.00

Date_______________Signature_______________________________________

Paid Cash__________Check #_____________Amount______________________