Certificate #:  Squadron:  Member Since: 

         Name:  Grade: 
      Address: 
         City:  State: Zip: 

   Home Phone:    Work Phone: 

        Email: 



        Current Squadron job: 

        Are you interested in a Squadron Position at this time?" Yes No Later
        Are you interested in a District Position at this time?" Yes No Later

              1st Choice: 
              2nd Choice: 
              3rd Choice: 

       Speciality Skills: 



    Please indicate the committees that you are interested in ( Check as many as you want )

     General Committees (Elected Positions)

           Auditing Committee
           Nominating Committee
           Rules Committee

     Standing Committees

           Budget/Finance Committee
           Educational Fund Committee
           Merit Mark Committee
           Flag & Etiquette Committee
           Educational Fund Committee
           Law Committee -  Are you a laywer? Yes No
           Officers Training Committee
           Planning Committee

     AD HOC Committees

           Travel Committee
           Journal Committee
           Manuals Committee

     Committees under the Executive Department

           Boat Show Committee
           Co-Op Charting Committee
           Liaison Committee
           Legislative Committee
           Public Relations Committee
           Safety Committee
           Vessel Safety Check Committee -  Are you currently an examiner? Yes No 
           Marketing Committee

     Committees under the Educational Department

           Boating Course Committee
           Seamanship Committee
           Piloting Committee
           Advanced Piloting Committee
           Junior Navigation Committee
           Navigation Committee
           Cruise Planning Committee
           Engine Maintenance Committee
           Instructor Qualification Committee
           Marine Electronics Committee
           Sail Committee
           Weather Committee
           Teaching Aids Committee

     Committees under the Administrative Department

           Membership Committee
           Member Involvement Committee
           Operations Training Committee
           Boating Activities Committee
           Harvey Collins Award Committee
           Leach Memorial Trophy Committee
           Port Captain Committee
           Inter-District Raft-up Committee
           Meetings Committee

     Committees under the Secretary's Department

           Computer Systems Committee
           District Directory Committee
           The Ensign Correspondent Committee
           District Historian Committee
           Personnel Committee
           Publications Committee

     Committees under the Treasurer's Department

           Insurance Liaison Committee
           Member Benefits Committee
           Ships Store Committee
           Property Committee

  Comments: