Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name*

First NameLast Name
Company (If Maritime Industry)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number*
Student E-mail*
example@example.com
Birth Date*

MonthDayYear
Did Someone Refer You to Chicago Maritime School?
Name
Choose the courses you want to attend (This is not the payment section)*

First Aid/CPR/AED - Classroom or HybridOUPV Online with In-Person Instructor SupportOUPV to Master less than 100 Gross Tons Upgrade OnlyOUPV/Master Upgrade to Mate/Master less than 200 Gross TonsUpgrade an Inland/Great Lakes Master Scope to Near Coastal (Up to 100 GT)Able Bodied Seaman with Lifeboatman Limited CourseLifeboatman Limited Only CourseLifeboatman Practical (Required for AB or LB LTD courses)Marine Radio Operator Permit (MROP) Prep Course and Exam ProctorMarine Radio Operator Permit (MROP) or FCC Exam Proctor Only
Course Start Date*

THIS IS THE PAYMENT SECTION - Only Choose What You're Paying For Today.*

Student Registration Form