Membership Application Please complete this form. All information will be kept confidential. To signup for the Captain School Consortium, please fill out the following form. All information will be kept private!Type of Membership *NewRenewalTransferOtherFull Name (first, middle and last) *Email *Full Mailing Address *Do you have a valid drug test dated in last 180 days? *yesnoDo you have a valid drug test dated in last 180 days?Are you a Merchant Mariner? *YesNoApplicantThis is the labelThis is the labelMerchant Mariner Reference Number or Social Security # *Date of Birth *Employer NameComments