Membership Application Name * Address * Address 2 City * State * Zip / Postal Code * Phone Number * Email Address * Is your boat trailered or in a marina? * TraileredMarina What marina? Boat name or registration number? How would you like to pay? * VISAMasterCardDiscover If paying by check please mail payment to: Lakeshore Towing 34 State Street Erie, Pennsylvania 16507-1474 Credit Card Number Credit Card Expiration Date (mm/yyyy) CVV Code Boat Information Boat Make * Length * Color Power Choose Your Plan Lake Erie U.S. Waters - $110.00PA waters Only - $90.00 Please note: Membership will not take effect until 24 hours after payment is received. Coverage is not provided for pre-existing conditions. Boat must be in good running order at time of purchase. Comments If you are human, leave this field blank.