Application - United States Power Squadrons
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UNITED STATES POWER SQUADRONS
®
Sail and Power Boating ( or 1-888-367-8777 )
1-a. Application
ACTIVE MEMBERSHIP
(See reverse for explanation of membership types)
Name (First/MI/Last)
Mailing Address:
City, State, Zip:
Telephone
Home (
)
Work (
)
E-mail
Fax (
)
Sex (M or F)
Birth Date
Spouse’s Name
ADDITIONAL ACTIVE MEMBERSHIP
(Add other adults in same household at a reduced membership rate)
Name (First/MI/Last)
Telephone
Home (
)
Work (
)
Sex (M or F)
Birth Date
E-mail
FAMILY MEMBERSHIP
(Add other adults/children in same household at a reduced membership rate)
1: ______________________________________ Birth Date
Sex (M/F)
(MM/DD/YY)
2: ______________________________________ Birth Date
Sex (M/F)
(MM/DD/YY)
3: ______________________________________ Birth Date
Sex (M/F)
(MM/DD/YY)
1-b. Application
APPRENTICE
SEA SCOUT
(check one)
Name (First/Last):
Mailing Address:
City, State, Zip:
Home Telephone
(
)
Sex (M or F)
Birth Date
E-mail
Fax: (
)
2. Personal Skills
(check all that apply)
Accounting/Finance
Hospitality, Meetings
Photography
Advertising/Marketing Skills
Management/Personnel/Purchasing
Public Speaking/Public Relations
Art/Drawing/Drafting
Membership/Member Involvement
Religion
Computers/Audio Visual
Medicine/Nursing
Telephone
Education/Instruction/Administration
Newsletter/Printing/Publishing
Writing/Editing/Grant Writing
Being a boat owner is not a USPS membership requirement; however, if you do own a boat we would be interested in
3. Boating:
knowing if it’s a [ Power ] or [ Sail ] Boat (circle one), the name of your boat: ________________________________,
and the overall length of your boat: _________________
Cert #
?
4. Which USPS member most influenced you to join our organization
5. Signature
Date ____________
__
SQUADRON ENDORSEMENT (This section to be completed by the local USPS unit to which this application is being submitted)
Applicant(s) Endorsed By
Date
Ex Com Approval (signature)
Date
Please indicate if you have completed an approved course: (Not a requirement for membership)
Date Completed
Educational Certificate Type (check one):
Certificate/Local USPS Boating Course
Certificate/Approved Equivalent Boating Course
Squadron/Provisional Name
Acct #
District
st
nd
rd
MEMCOM-1 04/07 1
COPY TO HQ (Toll Free Fax: 888.304.0813), 2 COPY TO SQD SEC/TREAS., 3 COPY TO SQD CH MEMBERSHIP
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