Lower Keys Guides Association

Guide Membership Application

    Guide Membership Application

    Name

    First*

    Middle

    Last

    Address:

    Street

    Apt/Suite

    City

    State

    Zip Code

    E-MAIL*:

    PHONE*:

    Please choose one box for each of the following statements:

    I certify that I am over the age of 18.

    YESNO

    I certify that I have resided in Monroe County, FL for a period of not less than one yearand have the residency requirementsto be a resident of the State of Florida for income tax purposes.

    YESNO

    If NO, please explain:

    Ishall, at all times, be in compliance with all rules and regulations as set forth by the United States Coast Guardas to safety and operation of the craft I shall operate while a Guide Member of this Corporation.

    YESNO

    Ishall,at all times, have a valid Coast Guard license number and appropriate Monroe County business occupation license and provide the same to the Board as part of the application process. The Corporation reserves the right from time to time to request this information to verify the ongoing compliance.

    YESNO

    My membership request is seconded by the following current Guide Member:

    Document checklist to attach with application:
    Merchant Mariner Credentials/Captain’s License
    Charter Captain Fishing License
    County or City Occupational License
    DISCLAIMER

    I certify that all information I have provided on this form and all supporting documentation is true and complete to the best of my knowledge. I give permission to committees to review information on this form and any additional supporting documentation submitted as part of this application. I further agree if chosen to submit any further documentation. I am aware this proposed Guide Membership shall be approved by a majority vote of the Board of Directors.

    SIGNATURE*

    DATE*

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