USPS Ship's Wheel Logo

Squadron Activities
Committee

 

General Public < Squadron Activities Committee > USPS Members

 

Port Captains
Registration Form

For asstistance with the form check the Frequently Asked Questions

 Purpose of Registration (select one)

 Date:   / / mm/dd/yyyy
 Squadron:  
 District No:  

USPS certificate number:

 Name:  
 Address:  
 City:  
 State:  
 Zip:  
 Phone:  Home:
   Business:
   Fax:
   Cellular:
 Email:  
 Ham Call:  
 Waterway:  
 PC State:  


Specific area or harbor:

 Boat Name:  
 Type:  

Privacy: Do you agree to opening the Port Captain's Roster to the Boating Public?

Approved by: (Requied for new listings)

If the Email address of your Commander or AO is supplied, electronic verification of your request will be attempted. If neither has an Email Address, please print the completed form, sign it and have your Cdr or AO approve it and mail it to the address below.

 

 Sqd Cdr or AO Email:

-or-

Port Captain's Name: __________________________ Date: _______________

Sqd Cdr or AO: _____________________________ Date: _______________



Comments to the Committee


 


Privacy | Trademarks | Disclaimer | WebMaster | ©2010 United States Power Squadrons