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.
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.