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
Choose the courses you want to attend*

Basic Boating Safety CourseBoat Safe Chicago Course - Advanced Boating Course (Includes Basic)Chart Navigation Course - BasicChart & Electronic Navigation Course - Advanced
Course Start Date*

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

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

$0.00

Student Registration Form