Membership Application Request/Info

Dear Captain or Guide,

Please fill in the fields below. Use the tab key to move to the next field or click on the field with your mouse. Be sure to include your email address or the form results will not be forwarded to us. Be sure to include name and address and all your USCG license information so that your membership application/ inquiry can be processed properly.

Our affiliates around the Great Lakes get great exposure and support by being members of this web site. Your business will grow and your boat won't be sitting at the dock!! Membership requires that you are currently engaged in the operation or ownership of a fishing business and are properly licensed.

Sign up today.

Captain Bob O'Brien

262-595-0047

Enter Your Name fax#

Email Addressday time Phone#

Street Addressnight time Phone#

CityStateZip code

U.S. Coast Guard or State License Number

Your Primary Port(s) of Operation

Years of Professional Experience

Type of Service/Membership Desired? Class A Class B

(Class A membership allows for Web page hosting/ Form useage/ Captains Forum and Free classifieds. Base Rate is $150 / year.

Class B membership allows you to place your current web page link on one of our index pages, and use of the Captains Forum. Base Rate is $100 / year.)

If you have a web-page currently Please List its address here:

(www.xxx.xxx/.... etc):

Please send me a Brochure

Memberhsip Chairman Please Respond to Me Via:

comments: Please Use the space below to ask about any specific needs or other questions about our Program.

If you do not have email service, simple print out this form and send it to:

Prime Time Charters of Racine, Inc.
WWW Div.
141 S. Lakeshore Drive #A1
Racine, WI 53403

Thank you for responding. Click "Submit Form" when you are ready to send us your inquiry.

Regards,

Captain Bob O'Brien

Charter Captains & Guides of the Greatlakes Home Page