Dock Application Dock Application To apply for a Dock for the season, please complete the form below. Payment can be submitted by EMT, credit card, or cheque along with your Insurance Declaration. Name * First Last * Last Membership # * Category Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Phone (Home) * Phone (Mobile) * Phone (Local) Email * Yacht Name * Make * Power or Sail? * Power Sail Hull Colour * LOA * LOA: Total length includes bowsprit and any other items protruding from the bow or stern of the vessel Beam * Draft * Extra Length Required Registered Name (if applicable) Or License Dinghy Storage Required? Yes No Dinghy Name/Registration Insurance Information Yacht Insurance Company * Policy Number * Insurance Broker/Agent * Liability Amount * Insurance Form on File Insurance Information Complete Expiry Date * NOTE: YOU MUST HAVE A MINIMUM OF $1,000,000 LIABILITY INSURANCE on your boat. You must submit a copy of your Insurance Declaration Page with this Application if we do not have one on file. Dock Fees Dock Type * Club Dock - Rate/ft: $37.96 Town Dock - Rate/ft: $41.34 TOTAL AMOUNT DUE INCLUDING TAX LESS YOUR $250 DEPOSIT Agreement Docks will not be reserved in anyone's name until payment in full and current proof of insurance is received by the Club. The Prince Edward Yacht Club reserves the right to assign docks. By accepting this offer to lease a dock managed by PEYC, I confirm that I have read and will abide by the Dock & Mooring Policies including the new policies related to Pollution Prevention. With your permission, PEYC will accede to a request from the local PEC MOE and Picton Fire Department for a list of Dock leaseholders' dock number, owner, and boat names and contact phone number, to help them begin an immediate response should they arrive on the scene to address a marine spill in progress. PEYC encourages this, as a fast response to any spill would help mitigate any possible fines and charges to the boat owner and protect the harbour water quality. Please check the box signifying your agreement to release your information. Yes, I agree to provide my contact information No, please do not include my contact information Full members wishing to defer their dock priority to the next year, please enter your initials in the box and enclose $100.00 Signature Clear Date reCAPTCHA If you are human, leave this field blank. Submit