ONE DAY SAFE BOATING COURSE REGISTRATION

NAME___________________________________D.O.B___/__/_____PHONE____________

ADDRESS________________________________________CITY____________ZIP________

YRS BOATING_________EMAIL________________________________________________

BOAT TYPE: POWER______ IB____ OB_____ IO _____ SAIL_____PWC _____ LENGTH _________

IF UNDER AGE 16, NAME OF PARENT OR GUARDIAN:

NAME____________________________________PHONE NO. _______________________

HOW DID YOU HEAR ABOUT THIS COURSE? ___________________________________________

INTERESTED IN JOINING THE AUXILIARY? YES___ NO ___ MAYBE ___

DATE REGISTERED______________ FOR COURSE DATED -  4/26/15 ____

PAID: 65.00 CHECK #_______CASH___________RCD. BY__________________________

PLEASE MAKE CHECKS PAYABLE TO: BRANFORD FLOTILLA 17-01 INC.          MUST BE IN BY. APRIL 20.

RETURN BY MAIL ONLY TO:

Branford Flotilla 17-01
c/o Norman Dahl, DDS
46 Park Place, Suite A
Branford, CT., 06405

SORRY NO REFUNDS UNLESS CLASS IS FULL. NO WALK INS ON DAY OF CLASS. THERE WILL BE NO REGISTRATION AT THE DOOR. ALL SEATS ARE PRE-REGISTERED.
-------DO--NOT--DETACH.-------THIS-WILL-BE-RETURNED.-------YOU-MUST-BRING-THIS-TO-CLASS.---------THIS-WILL-BE-RETURNED-------DO--NOT--DETACH.

QUESTIONS? CALL THE BRANFORD FLOTILLA BASE: 203-488-5349

LEAVE A MESSAGE ALONG WITH A PHONE NUMBER AND THE BEST TIME TO CALL.

CONFIRMATION FOR:____________________________________NO_____

ONE-DAY COURSE -APRIL 26, 2015   - 8 AM TO 6 PM

PAYMENT AND PRE-REGISTRATION IS REQUIRED. FIRST COME - FIRST SERVED. NO REGISTRATIONS AT THE DOOR.

HIGHLIGHTER PENCIL NOTEPAD SUGGESTED. YOU MUST BRING THIS CONFIRMATION TO CLASS.