REQUEST AUXILIARY INFORMATION

Please use this form to submit your information to this Division. Your information will be used to contact you, by the method you provided so that we can get Auxiliary membership information to you. All submitted information is confidential and won't be given to anyone outside the Coast Guard or the Coast Guard Auxiliary. Note however, information that is transmitted across the Internet or computer networks is subject to interception by unauthorized users.

Please provide the following contact information:

First Name:

Last Name:

Title:

Organization:

Street Address:

Address (cont.):

City:

State/Province:

Zip/Postal Code:

Country:

Work Phone:

Home Phone:

FAX:

E-mail:

How would you like for us to contact you (pick only one)?

Telephone
Fax
E-mail
Postal Mail

What is the best time to contact you?

Please describe your boating experience or interest (if any), personnel interests and reasons for considering the Coast Guard Auxiliary.

Please provide any additional comments, questions or special instructions that you would like to address, to this Division concerning your request for membership information.

Have you read over the information concerning Auxiliary membership, requirements and restrictions (pick only one)?
Yes or No

Last edited: 04.11.2005 12:10:14 AM

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