MARCO ISLAND CIVIC ASSOCIATION - RESIDENTS' BEACH

1770 San Marco Road #204, Marco Island, FL 34145

Phone: 239-642-7778 Fax: 239-642-8663

APPLICATION FOR 2007-2008 MARCO ISLAND RESIDENTS' BEACH USE

Enclosed is my check for $130.00 covering application fee for my non-transferable Residents' Beach membership. Fiscal year is September 1, 2007 through August 31, 2008. Fees are not prorated. PLEASE MAKE CHECKS PAYABLE TO MICA - RESIDENTS' BEACH.

I certify that I am a Marco Island resident, and in support of this application, I AM SUBMITTING HEREWITH PROOF that I qualify for membership by including legible copies of one of the following with my application:

t Copy of 2007 proposed tax statement or 2006 or more recent tax bill, or homestead exemption card for improved residential dwelling on Marco Island showing the street address. OR

t Copy of current homeowner's, wind, or flood insurance policy for my residential dwelling on Marco Island, showing the street address. OR

t Copy of current condominium maintenance fee billing for my residential dwelling showing the Marco Island street address. OR

t New property owners: copy of warranty deed or copy of closing statement.

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k I also wish to join the Marco Island Civic Association, therefore, enclosed is an additional $30, for a total of

$160. (MICA membership is $35. There is a $5 discount given when Residents’ Beach & MICA memberships are purchased

simultaneously).

k I’d like to help pay down the mortgage for the new beach pavilion. I’ve enclosed an additional ___________.

k For members wishing to permanently affix decals to their vehicles: License plate number(s) will appear on the Residents’ Beach decal(s). Therefore, I AM ALSO SUBMITTING: one or two [please circle] copies of current vehicle registration(s), showing the license plate number(s), in the names appearing on application.

If either vehicle is leased and your name is not shown on the car registration, please also submit copies of the

lease(s) or insurance card(s) showing your name. Vehicle titles will not be accepted.

ONLY THE ABOVE DOCUMENTS WILL BE CONSIDERED AS ACCEPTABLE PROOF OF RESIDENCY. ORIGINALS WILL NOT BE RETURNED TO YOU.

I understand that: 1) Residents' Beach membership will be granted only to natural persons (not corporations or trusts); 2) not more than one membership will be issued to any resident; 3) membership is non-transferable; 4) members entering Residents’ Beach without a decal affixed to their car (decal must match license plate) must present photo identification to the guard; 5) there is no refund of fees; 6) the fee to replace a car decal is $20.00. As a member of the Residents’ Beach I waive for myself and any of my guests any cause of action that may arise for damages of any kind and matter. I understand that any violation of membership rules and beach access regulations will be grounds for cancellation of my membership. Under penalties of perjury, I declare that I have read the foregoing application and that the facts stated in it are true.

MARCO RESIDENTIAL PROPERTY ADDRESS _______________________________________________________________ BUSINESS ADDRESS OR PO BOX IS NOT ACCEPTABLE

__________ ________________________________________________________________________

Date Signature of Applicant

Please print legibly

Name: ________________________________________________________________________________

Mailing Address: ________________________________________________________________________________

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Daytime phone #: ___________________________________ Fax #: ____________________________________

E-mail address: __________________________________