Application

  

Coast Guard Spouses’ Club of Sector New York

Membership Form - 2022/2023

Dues are $20 for the Club Year 

Payable by cash or check* or Zelle secnyspousesclub@gmail.com

Name: __________________________________________________________________________________________

Address: __________________________________________________________________________________________

Contact Phone Number: ( __________ )  ____________ - _______________  

E-mail: __________________________________________________________________________________________

Let us celebrate you, tell us your birthday: __________ / ___________ 

Spouse’s Info Command: Sector____ Station____ Bayonne____   MSST____

Rate and Rank**: _____________________

Ages of children**: ________________________________________________________________________________________

________________________________________________________________________________________

Would you like to be added to the club’s private Facebook page? YES________    NO________

(If yes, please provide the email address or name associated with your Facebook page) _______________________________________________________________________________

Do you prefer day events or night events? _________________________________________________________

Please sign to grant permission to the Spouses’ Club to use your image on our social media accounts and website. If you do NOT consent, please leave blank. ____________________________________________________________

*Make checks payable to: Coast Guard Spouses’ Club of Sector New York.  If a check is returned unpaid for any reason by the issuing bank, a fee of $30 will be issued to be paid to the Spouses’ Club.

** This information is primarily utilized for galley reservations and planning events.

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Below is for administration purposes only 

Dues Paid On_________________      Paid By:      Cash            Check Revised 6/4/22