MARCO ISLAND CIVIC ASSOCIATION - RESIDENTS' BEACH

1770 SAN MARCO ROAD, #204

MARCO ISLAND, FLORIDA 34145

239-642-7778

APPLICATION FOR 30-60 DAY WALK-ON PASS

2007-2008 RESIDENTS' BEACH

Enclosed is my check for $130.00 covering the application fee for a walk-on Residents' Beach pass. Fees are not prorated. CHECKS SHOULD BE MADE PAYABLE TO MICA - RESIDENTS' BEACH.

A walk-on pass can be issued for a rental period of 30 to 60 days, depending on the lease agreement.

By providing proper documentation of Marco Island residency, I will receive a 30-60 day walk-on beach pass, which will enable me to walk on to the Residents’ Beach at 130 South Collier Boulevard. In addition, I will be granted parking privileges at MICA’s Sarazen Park at 930 Swallow Avenue.

In support of this application, I AM SUBMITTING HEREWITH PROOF that I qualify for membership by including a legible copy of the following with my application:

o Copy of lease for a residential property on Marco Island with a term of not less than one month or copy of rental confirmation for a one month period from a real estate agent or property owner.

Lease must contain name, address & telephone number of landlord.

Dates of Rental Period: _______________________________________________________________________

Address of Rental Property: ___________________________________________________________________

DO NOT SUBMIT ORIGINALS.

I understand that: 1) Residents' Beach passes will be issued only to natural persons (not corporations or trusts); 2) not more than one pass will be issued to any resident; 3) a Residents’ Beach ID card for my use only will be issued at the MICA office when photo identification is supplied; 4) fees are not refundable; 5) passes presented for entry will not be honored if, upon identification check, it is determined that the individual presenting the pass is not the individual to whom the pass was issued; and 6) passes are not transferrable. 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.

___________________ _______________________________________________________________________

(Date of Application) (Signature of Applicant)

PLEASE PRINT:

_________________________________________________________________

(Name)

HOME MAILING ADDRESS: _________________________________________________________________

_________________________________________________________________

DAYTIME TELEPHONE NUMBER: ______________________________________________________________