Course Registration Form

THIS IS THE PAYMENT SECTION*

Basic Boating Safety Course (Power or Sail Boats)

$70.00 Quantity

Total

$0.00

Student #2 Name (Only if paying for 2 persons on this registration)

First NameLast Name
Student #2 Address (If same as above leave blank)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student #2 E-mail
example@example.com
Student #2 Mobile Number
Student #2 Birth Date

MonthDayYear
Additional Comments
Should be Empty: