Revised 10-07

Lee County Professional Guides Association
A Non-Profit Organization
Membership Application

Date: __________________

Name: ______________  _______________________  _______________________  _____
             Capt., Mr., Mrs., Ms.                Last Name                                         First Name                            MI

Address: _________________________________________________________

City: _____________________  State: ____________  Zip Code:  ____________

Home Phone:  (____) ______________  Business Phone:   (____) _____________

Cell:  (____) __________  Pager: (____) __________ Fax:   (____) ___________

Email Address:  ____________________________________________________

Web Site (if Captain):  ________________________________________________

Type of Membership:  ______________  Amt. Enclosed:  $_______  Ck. #:  _____
                                          (Guide, Angler, Corporate)

 Membership Fees:  Guide - $50.00 | Angler - $25.00  | Corporate:  $250.00 

Below for Guide Applications Only
Boat Information

Make: ____________  Length:  ________  Type: _______________ H.P.: ______
                                                                                 (Flats, Skiff, C.C., Sport fish, etc)

Fishing Information

Max. No. of People: ____ Fishing Area: _____________ Fishing Type: ___________
                                                                  Back Bay, Flats, Offshore)                 (Spin, Fly, Wrecks, Reefs, Trolling)

I presently hold a current Coast Guard License (NUMBER:___________________), State of Florida Commercial Saltwater Fishing License and maintain commercial insurance $______________(dollar amount) in Liability Coverage.  (If Captain, attach Coast Guard License, Occupational License, Saltwater vessel license & Insurance Certificate).

                                                                                                                                       X__________________________________________________________
                                                                                                                                                                  Signature of Guide                                       

Below for Corporate Applicants Only 

Corporation Name:  _________________________________________________

Address:  _________________________________________________________

City: _____________________  State: ____________  Zip Code:  ____________

New Membership _____   Membership Renewal