ASSIGNMENT TO DUTY
US COAST GUARD AUXILIARY 095-47-03
Name
First Name
Middle Initial
Last Name
MEMBER ID
Your 7 Digit Member #
E-MAIL
example@example.com
MOBILE NUMBER
Format: (000) 000-0000.
Emergency Number
Format: (000) 000-0000.
Name of Emergency Contact
DUTY LOCATION
Date
-
Month
-
Day
Year
Date
Duty Type
Please Select
Flotilla/Division/District Meeting
Human Resource Meeting with Applicant
Auxiliary Training Event
D-Train
Vessel Exam
Program Visitation
Public Affairs Event
Radio Watch Standing
Marine Safety Event/Training
Whiting Boathouse
RISK ASSESSMENT
Please Select
LOW
MEDIUM
HIGH
Additional Comments
Submit
Clear Fields
Should be Empty: