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MCBA Membership Application

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Join Michigan Charter Boat Association

Please take a few minutes and fill out the registration form below. If you need assistance,
please send an email to membership@michigancharterboatassociation.org.

Price:

$30 for 1 Year

Business Profile

New Member

Captain

Retired Captain

First Mate

First name:* First name is Required

Last name:* Last name is Required

Birth Date:* Birth Date is Required

SSN# (last 4)xxx-xx-:* SSN# (last 4)xxx-xx- is Required

Email:* Email is Required

Cell Phone*: Cell Phone* is not valid

USCG License No.:* USCG License No. is Required

USCG Lic Exp Date:* USCG Lic Exp Date is Required

Address Line 1:* Address Line 1 is Required

Address Line 2: Address Line 2 is not valid

Country: Country is not valid

State: State is not valid

City:* City is Required

Zip/Postal Code:* Zip/Postal Code is Required

Address Line 1: Address Line 1 is not valid

Address Line 2: Address Line 2 is not valid

City: City is not valid

State: State is not valid

Zip/Postal Code: Zip/Postal Code is not valid

Business Name: Business Name is not valid

Website (eg. www.xxxx.com): Website (eg. www.xxxx.com) is not valid

Business Phone: Business Phone is not valid

Primary Category:* Primary Category is Required

Enrolled in Michigan Catch and Cook?

Enrolled in Michigan Catch and Cook?:* Enrolled in Michigan Catch and Cook? is Required

Yes No

Designated Employer Rep. Name (DER): Designated Employer Rep. Name (DER) is not valid

Designated Employer Rep. Phone:* Designated Employer Rep. Phone is Required

No Boat

Primary Boat Name:* Primary Boat Name is Required

Boat Make (ex. Bertram): Boat Make (ex. Bertram) is not valid

Length (just feet eg. 26): Length (just feet eg. 26) is not valid

Vessel doc no. or M.C. #:* Vessel doc no. or M.C. # is Required

Vessel Inspected?:* Vessel Inspected? is Required

Inspection Agency:* Inspection Agency is Required

Donate to the Conservation Fund- select amount.: Donate to the Conservation Fund- select amount. is not valid

Lake Port/River Information

One Primary lake or river port combination is included with your membership. You can add up to 4 additional ports below for $30 additional cost per year.

Lakes *

Port *

Fish Species *

Membership Add-ons

Add Additional Port 1 ($30 / Year)

Add Additional Port 2 ($30 / Year)

Add Additional Port 3 ($30 / Year)

Add Additional Port 4 ($30 / Year)

Add New Member ($65)

Add First Mate ($40 / Year)

Add Captain ($140 / Year)

Add Retired Captain ($5 / Year)

Add Waterfowl Hunting ($30 / Year)

Add Diving ($30 / Year)

Add Sailing ($30 / Year)

Add River Fishing ($30 / Year)

Add Cruise/Excursion ($30 / Year)

Add Fishing ($30 / Year)

Add Captain for Hire ($30 / Year)

Add Conservation fund ($5 / Year)

Add Conservation fund ($25 / Year)

Add Conservation fund ($50 / Year)

Add Conservation fund ($100 / Year)

Add Bumper sticker (Free) (Free for 1 Year)

Add 6" x 9" Inspected year placard (Free) (Free for 1 Year)

Add Drug Program Zero Tolerance Decal (Free) (Free for 1 Year)

Add MCBA Logo Decal (Free) (Free for 1 Year)

Add Water Proof Boat Emergency Checklist (Free) (Free for 1 Year)

Web Account Password

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn't Match

Password Strength Password must be "Medium" or stronger

Affirmation of Authenticity

By submitting this form I certify all information is correct* You must agree to the affirmation

Initials:* Initials Required

No val

Please fix the errors above

Please review your information before you click submit, as you cannot go back.

Why not join MCBA?

Michigan Charter Boat Association has over 600 Captain members.

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© Copyright Michigan Charter Boat Association - P.O. Box 354 - Lake Leelanau, MI 49653 - 1-888-872-0294

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