The Maritime Consortium, Inc

The Maritime Consortium, Inc

If your company is not currently enrolled, please go to new membership application

Note: Please have your renewal invoice handy for reference information.

Important: if renewing one person, please click here for a notice

Account Number

Price Code
Contact information
Company
Contact Name
Address
Street Address

Address Line 2

City

State

Postal / Zip Code
Phone - (###) - ### ####

Fax
Email
VESSEL IDs (see here for regulation)
Crew Members to Renew

Enter Social Security Numbers or MID Numbers for members that are to be renewed (already listed on your invoice).

#1

add more

Crew Members to Add

Enter full name, Social Security Number, date of birth, and pre-employment status for any new crewmembers that are to be added.

Note: Maritime ID Cards will be issued upon receipt of documentation of pre-employment status.

Name Full Name Social Security Date of Birth / MM / DD YYYY

Pre-Emp Status

add more

Renewal Fee

Description		Number	Cost	Amount
1. Captains and Crewmembers RENEWED (from above) *$75 in AK, HI, PR, VI ($90 in Saipan and Guam)
2. Captains and Crewmembers ADDED (from above) *$75 in AK, HI, PR, VI ($90 in Saipan and Guam)
3. Pre-employment tests (for any added crew above)
4. Consortium Handbook (contains USCG regulations)
5. Additional vessel stickers
6. M-PAKs (needed for each employee) new Rule here
TOTAL

Creditcard information
Credit Card Type VISA MASTERCARD AMEX
Please select at least one.
Credit Card Number ex: 1111222233334444 (no spaces)

Credit Card Expiration
ex: "12/11"
Cardholder Name Full Name
Required for submission

printed on the back of my renewal form and here
I have read and agree to the 2012 renewal agreement YES
Any special instructions when processing your renewal?