Music City Powerboat Association
A Non-Profit Corporation - Hendersonville, TN
MCPA Membership Application
(March 1, 2008 - March 1, 2009)
Please Print
Name:
First Mate Name:
Address:
City, State, Zip:
Home Phone:					Work Phone:
Cell Phone:
E-Mail Address:
Boat Year:			Make:			Model:			Length:
Offshore Only Screen Name (if applicable):
TWRA Registration
Number & Expiration:
Name of Vessel &
Port of Call (if applicable):
Boat Insurance Provider &
Expiration Date:
Proof of Insurance:			No	or	Yes	Will provide within 10 days
NOTE:		All of the above information will be held private with the Board of Directors of the MCPA and
		not released to any other person(s) or entity.  Phone numbers, e-mail and home addresses
		will be available to Full and Social Members ONLY with your approval.								Initial
Indiciate the type of membership you are applying for.  Enclose form with payment for the amount shown below
(all checks must be made payable to Music City Powerboat Club or MCPA) and proof of insurance.  Please mail to: MCPA
182 Cumberland Dr.  Hendersonville, TN  37075 or simply hand deliver to any Director of the Association.  Applicants
will be notified via mail, e-mail or fax of their status.  Memberships are subject to the Articles of the Incorporation and
the By-Laws of MCPA.  There will be a $20.00 returned check fee.
FULL MEMBERSHIP:
Annual dues: $150.00 Benefits include 50% off annual Fun Run Event, access to all events
2 full membership ID cards, 2 dinner tickets for annual Christmas Party.  Must be powerboat owner and 21 years of age.
SOCIAL MEMBERSHIP:
Annual Dues: $75.00 Benefits include access to all events, 2 social membership ID cards,
2 dinner tickets to annual Christmas Party.  Must be 21 years of age.
Signature:								Date:
First Mate Signature:								Date: