The "Certificate of Recognition for Lifesaving" is awarded to members of the Civil Air Patrol "who save a human life, but do not meet the criteria for the Bronze of Valor or Silver Medal of Valor." A member may be awarded this decoration for participation in a transport mission of either blood or organs, in which case he or she is presented with a basic ribbon and a certificate that accompanies the decoration. A silver star is attached to the ribbon in recognition of lifesaving actions other than blood or organ transport which still do not meet the requirements of the higher awards. Subsequent awards are denoted by the addition of bronze and silver clasps to the ribbon. If more than three devices are authorized for wear on this ribbon, a second ribbon is worn to the left (from the point of view of the wearer) of the initial ribbon. If future awards reduce the total number of devices to three the second ribbon is removed. All nominations for this award must be approved by the relevant CAP wing commander. This award does not come with a full-sized medal of its own, though a miniature medal is available for senior members to wear on their mess dress uniforms.