Membership or Directory Update Form

Members may update their directory information by filling out the new information in this form. The new information is sent to the Membership Chairman when the "Submit" button is clicked. Use the mouse or tab key to move around in the form; do not use <ENTER> or <CR>.

Primary Member Name:(required)

Telephone number:

Other Member Name:

Mobile number:

Address 1:

Address 2:

City:

State:

Zip Code:

E-mail:(required)

Is this a new email address?(Required)

Yes No

How you want to be listed in the Directory, e.g. Tom & Jane Nemo:

What, if any, USCG license do you hold? (Required)

Vessel Name:

Vessel Model:

Vessel Year:

Vessel length:

Marina Name:

Marina Location:

How do you want to receive information on club activities? You must respond to each of the following three methods.

Email. (Required)

Yes No

Answering yes means that you opt-in to the HSA-1 email listserver.

US Postal Service. (Required)

Yes No

HSA-1 Web site. (Required)

Will check frequently. Will check seldom or never

Liability Disclaimer and Insurance Coverage

As a member of HSA, Station#1, I agree to abide by the rules and policies of HSA, Station#1. I certify that the information in my application or membership renewal is correct and that I shall maintain a liability insurance policy on my vessel. While HSA, Station#1 stresses safety in every phase of the activity, sailing is not without risk. In agreeing below, I assume any and all risks to me, my guests, and my vessel, whether on board, swimming, on shore or in any other manner. I shall not attempt to hold HSA, Station#1 or its Board of Directors or the organizers and leaders of any HSA, Station#1 activities liable for any injury, illness, or damages incurred. I understand and agree that my participation in any HSA, Station#1 activity is done voluntarily and with full knowledge of the risks inherent therein.

I have read and agree to the terms of the disclaimer. (Required)	Agree Do not agree
I/We have insurance coverage for my/out vessel which includes liability. (Required)	Yes No


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