Recruitment Form

Please fill out the information below as completely as you can. Our recruiters will review your application and determine your fitness for service.

NAME:

STREET ADDRESS or PO BOX:

CITY: STATE: ZIP:

CELL PHONE: -

HOME or WORK PHONE: -

EMAIL:

WEBSITE:

AGE:

GENDER: Male Female

Are you willing and able to provide service at Conch Republic Military Functions?

Yes No

If so, areas of expertise (describe):

Do you hold a Captain’s License: Yes No

Class of License:
Years of Experience:

Do you hold a Pilot’s License: Yes No
Class of License:
Years of Experience:

Do you own (or have access to) a boat or plane? Yes No

If so, please describe:

Do you own (or have access to) cannons, fire arms or black powder weapons? Yes No

If so, please describe:

PREVIOUS MILITARY OR MERCHANT MARINE SERVICE (please describe below):

Rank and Rate at time of honorable discharge:

Branch (or Branches) served:

YES! COUNT ME IN TO HELP DEFEND THE REPUBLIC!  I HAVE READ AND AGREE TO ADHERE TO THE MILITARY ARTICLES OF THE CONCH REPUBLIC.

$50 General Membership in the Conch Republic Navy
(Includes CRN Commissioning Certificate, CRN Cap, CRN T-Shirt & CRN $100 Peace Bond)

$100 VIP Membership in the Conch Republic Navy
(Includes CRN Commissioning Certificate, CRN Cap, CRN T-Shirt & CRN $100 Peace Bond)