UNITED STATES WATER PATROL
Application

Name ___________________________ D.O.B._____________ Age. ______
Mailing Address. _________________________________ City____________________
State. _______________ Zip. _________ -_______
Day Phone._____-_____-_________
Night Phone._____-______-_______
E-mail. ________________________________

BOAT INFO:
Type Boat.__________________ Year._______ Length.______ Beam_______
Inboard/Outboard____________ Type Engine________________________

EXPERIENCE: Years boating experience.
Fresh water______ Salt water______ Other_______________
Have you ever taking any safe boating courses. If yes name course and year.
1._________________________________________________________________________
2.__________________________________________________________________________
Military experience:
Branch_____________ from_________ to____________
Law Enforcement experience:
Dept._________________ Year________ State___________
List any other experience that you feel may be useful. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________


Signature_______________________  Date_______________

The United States Water Patrol is a uniformed volunteer organization dedicated to Homeland security and Public safety on and along our Nations waterways.

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