**Please note - if you are unable to submit your Moorage Request Form for any reason, please contact us via (250) 622-2628, via VHF on Marine Channel: 66A, or via email at cowbaymarina@princerupert.ca

Name And Surname:

Phone Number:

E-mail:

Arrival Date:

Departure Date:



Vessel Name:

Vessel Length (ft):

Registration Number:

Power Requirement: (None,30/50/100amp)

Additional Notes: