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Personal Information

Full Name:    
Address:    
Home Phone: Alternate Phone:
Email:    
Slip or RV Space:    
Birth Date: Marital Status:  
 
Driver’s License Number:    
Spouse’s Name: Spouse’s Work Phone:  
 

Job Information

Title: Spouse’s Title:  
 
Company: Spouse’s Company:  
 
Work Location: Spouse’s Work Location:  
 
Work Phone: Spouse’s Work Phone:  
 
Email: Spouse’s Email:  
 

Emergency Contact Information

Full Name:    
Address:    
Primary Phone: Alternate Phone:
Relationship:    

Additional Members

Member 1: Birthday:
Member 2: Birthday:
Member 3: Birthday:
Member 4: Birthday:
(Attach Copy of Driver’s License and Registration)
 

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Contact Us

Long Cove Marina & Yacht Club

14629 Rainbarrel Road
Charlotte, NC 28278

Tel.No. 704-588-1467

Family Friendly and Fun
Call today for info:

Email: Info@LongCoveYachtClub.com

Cloudy Days at Long Cove