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
Format: (000) 000-0000.
Student E-mail
example@example.com
Birth Date

MonthDayYear
Did Someone Refer You to Chicago Maritime School?
Name
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Choose the courses you want to attend
Course Start Date

Basic Boating Safety Course (Power or Sail Boats)

$85.00 Quantity

Boat Safe Chicago - Advanced Boating Course - Includes Basic Course (Power or Sail Boats)

$225.00

Boat Safe Chicago - Chart Navigation Course - Basic

$225.00

Total

Student Registration Form