Sailing Certificate - PDF - PDF by bmm18288


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									                                                                                                                 Write your
    US SAILING INTERNATIONAL PROFICIENCY CERTIFICATE                                                            membership #
                     **APPLICATION**                                                                             the photo
                         **You must be a US Citizen to apply for this certificate**                               and clip

Name:                                                              Date:

                   Street                                       City               State         Zip

Phone:                                    Email:

US SAILING #                                       (Must be current, if not, contact membership to renew)

Logbook sticker #’s for: Basic Keelboat # _______       Basic Cruising #           Bareboat Cruising # _______

We ask that you adhere to the following regarding pictures:

         2x2 inches in size
         Taken within the past 6 months, showing current appearance
         Color or black and white
         Full face, front view with a plain white or off-white background
         Between 1 inch and 1 3/8 inches from the bottom of the chin to the top of the head
         Taken in normal street attire
         Uniforms should not be worn in photographs. If wearing head covering daily for religious or medical reasons
         include a statement explaining that.
         Do not wear a hat or headgear that obscures the hair or hairline.
         If you normally wear prescription glasses, a hearing device, wig or similar articles, they should be worn for
         your picture.
         Dark glasses or nonprescription glasses with tinted lenses are not acceptable unless you need them for
         medical reasons. A medical certificate may be required.

    If you are sending us a photo electronically for us to print, please email this document and image to

International Proficiency Certificate                                                    25.00
Member supplied photo                                                                     0.00
Member supplies digital image for US SAILING to print *$10.00                         $______
Shipping and handling                                                                     5.00
Sub Total                                                                             $______
RI sales tax (if applicapable) 7%                                                     $______

TOTAL DUE US SAILING                                                                  $______

   Enclosed is my check/money order payable to US SAILING

or Charge my        Visa     MasterCard      American Express

Card No                                                                        Expiration Date _____/_____


    Please mail to: US SAILING, POB 1260, Portsmouth RI 02871 or fax to 401-683-0840.

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