Pirates Cove Beach Association
Mashpee, Massachusetts
Since 1963
APPLICATION FOR WATER VESSEL STICKER
PCBA Private Beaches
Property Owner Name: ____________________________________________________________
Cove Property Address: ____________________________________________________________
Vessel Description:
Boat/Dinghy
Canoe
Kayak
Inflatable
Other
Vessel Length: _______ ft. ______ in. Color: __________________________________________
Vessel Material:
Aluminum
Fiber
Rubber/Vinyl
Other
Vessel Make: ________________________________
Ser. No.: _________________________
CERTIFICATION: I, the above-named PCBA property owner, hereby certify that I have been given a
copy of the PCBA Small Vessel Control Program, that I have read and understand my obligations in
the use, by me, my family, and my guests of my vessel on any of the private PCBA beaches, and that
I, my family, and my guests use such beaches with the understanding I, and they, do so at our own
risk to our person and the vessel identified herein.
SIGNATURE: ___________________________________________
The following for PCBA use only:
-
DATE: _________
Authorized by
Property owner has paid current year dues:
________
Property owner had not paid current year dues,
o But this payment constitutes dues paid current: ________
Issued Vessel Sticker # ________________
________
Paid by Ck. # _____ Date _______ Amt. $ _______________
Contact: Shirley Boutilier, Financial Secretary, (508) 477-5017 shirleyboutilier@gmail.com
44 Buccaneer Way
Return to: PCBA, PO Box 362, Mashpee, MA 02649 (or drop off at 44 Buccaneer Way)
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