Boat America Course Registration Form

Boat America Course Enrollment Form

Each student, even if a member of the same family, will need to complete an individual registration form
Date*
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail*
Phone Number*

Area CodePhone Number
Date of Birth*
Class Date
Class from 9am to 5:30pm.
Best time and method to contact you.
How did you hear about our course?
Comments or questions:
Course Fees:

Course fee is $35 for an individual registration. There is a family rate of $35 for the first family member, then $25 for each additional family member taking the same course on the same date. Payment Methods: If paying by check make check payable to "USCGAUX Flotilla 22." Please mail your check to USCG Auxiliary, 710 Independence Lane, Acworth, GA 30102. Cash payments may be taken on the day of class.
Should be Empty:

Boat America Course Enrollment Form