Registration Form

Join the Great Lakes Charter Association

If you would like to join the G.L.C.A. please do one of the following:

• Send a check or money order payable to Great Lakes Charter Association for $25.00 annual membership, or $100.00 lifetime membership to:

Great Lakes Charter Association

6128 Deckerville Rd. Deford, Michigan 48729

• Complete the convenient on-line registration form below.

Registration Form

Please provide as much of the following contact information as you can:
Note: We are not accepting credit cards at this time. Please use PayPal, for your transactions. Pay to thirtylb@tband.net
This information is kept confidential for Great Lakes Charter Association internal use only and will not be released or distributed to other persons or parties.

Name

Title

Organization

Street Address

Address (cont.)

City

State / Province

Zip / Postal Code

Country

Work Phone (xxx-xxx-xxxx)

Home Phone (xxx-xxx-xxxx)

FAX (xxx-xxx-xxxx)

E-mail

URL

Type of Charters Fishing Charters River Charters Pleasure Cruises
Dive Charters ( check all that apply )

Ports Enter Ports, Marinas, or Cities fished from in this box.

Gamefish Enter game-fish that you fish for in this box.

Vessel is State Inspected U.S.C.G. Approved ( check all that apply )

Membership Annual $25.00 Lifetime $100.00

Comments or Questions

Name
Title
Organization
Street Address
Address (cont.)
City
State / Province
Zip / Postal Code
Country
Work Phone	(xxx-xxx-xxxx)
Home Phone	(xxx-xxx-xxxx)
FAX	(xxx-xxx-xxxx)
E-mail
URL
Type of Charters	Fishing Charters River Charters Pleasure Cruises Dive Charters ( check all that apply )
Ports	Enter Ports, Marinas, or Cities fished from in this box.
Gamefish	Enter game-fish that you fish for in this box.
Vessel is	State Inspected U.S.C.G. Approved ( check all that apply )
Membership	Annual $25.00 Lifetime $100.00
Comments or Questions