Important: if renewing one person, please click here for a notice.
Account Number (from upper-right of Renewal Invoice)
Please use the following fields if you have corrections to your address(not necessary if your address has not changed)
Company:
Contact:
Address:
City:
State:
Zip:
Phone:
VESSEL IDs (see here for regulation)
Fax:
E-mail:
CREWMEMBERS TO RENEW
Enter Social Security Numbers or MID Numbers for members that are to be renewed (already listed on your invoice)
#1
#8
#2
#9
#3
#10
#4
#11
#5
#12
#6
#13
#7
#14
CREWMEMBERS TO ADD
Enter full name, Social Security Number, date of birth, and pre-employment status for any new crewmembers that are to be added.
NAME
Social Security
Date of Birth
Pre-Employment (check one)
#1 Licensed Unlicensed
Needs Test Exempt
#2 Licensed Unlicensed
#3 Licensed Unlicensed
#4 Licensed Unlicensed
#5 Licensed Unlicensed
Note: Maritime ID Cards will be issued upon receipt of documentation of pre-employment status.
RENEWAL FEE
Description
Number
Cost
1. Captains and Crewmembers RENEWED (from above)
$60 per person*
2. Captains and Crewmembers ADDED (from above)
3. Pre-employment tests (for any added crew above)
$55 per test
4. Consortium Handbook (contains USCG regulations)
Required for submission: I have read and agree to the current renewal agreement
(printed on the back of my renewal form and here)
Any special instructions when processing your renewal?