Please copy to
your word processor, fill out and email to Dan
Forby, FSO-OP
MEMBER
NAME: _____________________________________ MEMBER NUMBER:___________________________
PHONE:
HOME: ____________________________________CELL _________________________________________
WORK_____________________________________
EMAIL_______________________________________
QUALIFIED
AS COXSWAIN? YES____ NO____
DESIRE COXSWAIN RATING? YES ____ NO ____
CREW
QUALIFIED? YES ____ NO ____
DESIRE BOAT CREW RATING? YES ____ NO ____
DO
YOU OWN A FACILITY? YES____ NO____
IF YES, IS IT TRAILERABLE? YES____ NO____
DO
YOU OWN A VHF FM RADIO? YES____ NO____
IF YES IS IT MOBILE? YES____ NO____
FITNESS:
DO YOU HAVE ANY PHYSICAL RESTRICTIONS THAT AFFECT YOUR ABILITY
TO FUNCTION AS A CREW PERSON ON AN OPERATIONAL FACILITY? YES____
NO____
ARE
YOU COMMUNICATIONS QUALIFIED? YES____ NO____
DO YOU WANT TO BE? YES____ NO____
AVAILABILITY
CHECK
APPLICABLE DAYS AND TIMES:
MONDAY AM____ PM____
TUESDAY AM____ PM____
WEDNESDAY AM____ PM____
THURSDAY
AM____ PM____ FRIDAY
AM____ PM____
SATURDAY AM____ PM____
SUNDAY
AM____ PM____ CHECK WITH
ME MY SCHEDULE VARIES ____
SPECIAL QUALIFICATIONS
INDICATE
ANY SPECIAL TRAINING OR EXPERIENCE
YOU HAVE THAT MIGHT BE USEFUL IN OUR EFFORTS:_
________________________________________________________________________________________________________
