DISTRICT:_______ SQUADRON:____________________________

Only squadrons may apply for participation in this program. A requirement for participation is that an applying squadron's executive committee review the proposed long term commitment involved and vote affirmatively on it. Has this been done?__________

CHART(S) REQUESTED FOR ADOPTION:

Chart # ____________ (Entire chart, Y / N )
If (N), indicate portion of chart desired. If part of a chart is to be adopted, a copy of the chart with the proposed area outlined should be attached to this application.

NUMBER OF BOATS AVAILABLE ANNUALLY FOR USE IN THIS PROGRAM?________

NUMBER OF SQUADRON MEMBERS AVAILABLE ANNUALLY FOR PARTICIPATION IN THIS PROGRAM?_____

NAME AND ADDRESS TO WHOM ADOPT-A-CHART MATERIALS SHOULD BE SENT:

_____________________________________________________

_____________________________________________________

_____________________________________________________

Phone:____________________Email_________________________

SQUADRON COMMANDER'S SIGNATURE_____________________________DATE:____________

Forward to current R/C.
Confirmation of your application and/or receipt of Adopt-A-Chart materials from NOS will be within 4 weeks of receipt of your application. Contact your Area Representative should this not be the case.

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RESERVED FOR NATIONAL COMMITTEE USE:

NATIONAL COMMITTEE SIGNATURE:________________________________________

NOS SIGNATURE:_______________________________________________________