Auxiliary Id Card Application
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1AUXILIARY ID CARD APPLICATION
ALL INFORMATION IS REQUIRED TO CREATE YOUR CARD
Please insert information in the boxes below
1. STATUS
(ACTIVE)
(RETIRED)
(HONORARY)
(COMMODORE)
2. NAME
First
Middle Initial
Last
3. 7-DIGIT MEMBER NUMBER
4. QUALIFICATION LEVEL
(Initially IQ) (Basically BQ) (AUXOP)
5. DATE OF BIRTH
Year
Month
Day
6. WEIGHT (pounds)
7. HEIGHT (inches)
8. HAIR COLOR
9. EYE COLOR
10. BLOOD TYPE (or UNK)
FLOTILLA NUMBER
0 9 5
Street Address
City
State
ZIP
+ 4
EMAIL
PHONE
Form RB_AUXID_0609
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Parent category: Legal