1.
International Federation of Shipmasters‘ Associations
202 Lambeth Road • London SE1 7JY • United Kingdom
Phone: +44 20 7261 0450 • Fax: +44 20 3468 2134 • Email: HQ@ifsma.org • Website: www.ifsma.org
IFSMA
ATSEA
UNITY FORSAFETY
Application Form for Individual Membership
(Please type or complete in black ink, using BOCK LETTERS)
Family Name: ……………………………… First Name(s): ……………………………….............
Nationality: ………………………………… Date & Place of Birth: ………………………………
Permanent Address: …………………………………………………………………………………….
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
Tel: …………………………………………. Mobile: …………………………………………………..
Email: ……………………………………………………………………………………………………..
Master Mariner’s Certificate/Licence No.: …………………………………………………………..
Issuing Authority/Government: ……………………………………………………………………….
Other Qualifications: ……………………………………………………………………………………
Number of years in command of a sea-going ships: ………………………………………………..
Are you a member of your National Association, if any?: …………………………………………
National Association name & address OR website: ………………………………………………..
………………………………………………………………………………………………………………
Brief details of Career stating current trade: ……………………………………………………….
………………………………………………………………………………………………………………
Details of Nautical Education, including any Pre-Sea Training: ………………………………..
………………………………………………………………………………………………………………
Please indicate any special marine interests, or areas in which you could help IFSMA: ……
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
Signature: ……………………………………….. Date: ………………………………………...
