Rochester Power Squadron
Merit Mark Information Form
Name:
Last
First
M.I.
Certificate No.:
Today’s Date:
Select Year
I have been involved in the following activities in support of District 6 for the calendar year of:
Squadron Commander’s Dept.
2004
Executive Dept.
Explain duties and time spent:
Educational Department
Staff Officers
Local Board For Boating
Advanced Grades
Elective Courses
Explain duties and time spent, and/or course sessions taught, and/or sessions proctored:
Administrative Department
Secretary’s Department
Explain duties and time spent:
Treasurer’s Department
Explain duties and time spent:
Standing Committees
General Committees
Other Specialty Committees
Explain duties and time spent:
Check all that apply
Spring Council
Spring Conference
Fall Council
Fall Conference
Educational Workshop
Meetings Attended/Other
National Meeting
Governing Board (non member)
Other squadron Meetings
Other Squadron Functions
Deep 6 Articles Submitted
Ensign Articles Submitted
Explanation on any of above checked:
Explain any assignment not listed above:
This form is the application for a Merit Mark that is awarded to a member for his or her efforts in personally
furthering the interests, programs, and objectives of Rochester Power Squadron, a unit of the United States Power
Squadrons. It is a coveted award, for it is largely the only official recognition a member receives for his or her
efforts. Only one is awarded each year, no matter how extensive the contribution. Each member who has
participated in one or more of the squadron activities should complete this form and return it to the Squadron Merit
Mark Chairman by no later than 20 October of each year.
Merit Mark Chairman:
Squadron Dept. Bridge Officer:
Sqauadron Commander:
Date:
Date:
Date: