Moorage Request Form – Rose City Yacht Club

New Slip or Improvement Request?

If Improvement Request, Please State Reason

Member Name

First

Last

Co-owner, if any

First

Last

This information may be confirmed with the appropriate state vessel titling agency. Leave blank if none.

Email

Contact Telephone

Secondary email, if any

Make

Boat Name

Propulsion Type

Length

Model

Registration Number

Beam

Draft

Date Moorage Needed

Walk(s) Preferred

Please attach a copy of the Declarations Page

Insurance Company

Policy #

Expiry Date

Polution Liability

Wreck Removal

Declarations Page Upload

Drag & Drop Files, Choose Files to Upload

Please upload your declarations page in PDF, JPG or PNG format. Maximum file size is 2MB.

**Please read the current Moorage Rules published On the Membership Page of the RCYC Website.

Dock Power: Only a 30 amp marine-rated cord is allowed, and the cable run to your boat must be continuous. A strain-relief pennant is required.

All moored vessels MUST display current registration decals.

Signature

Clear Signature

Date

Text on name plaque

Two line max, or provide your own plaque