USPS America's Boating Course    Registration Form
When 2015 Schedule is posted, Register quickly to reserve a place.   << Six easy steps >>
Fill out (type in information) the registration form, Print it and mail WITH your check to confirm reservation.

Please mail at least 10 days prior to date of class.

1   Check the appropriate Session (You may use one form for multiple students in same family with same address.) 

DATES

DAY

TIME

LOCATION

22-April-2017 Saturday 9:00 AM - 5:00 PM Lake Wylie Marina 310 Blucher Circle Lake Wylie, SC

2   Type the requested information for each student you wish to register in the lines below: 

TO REGISTER - Check appropriate course in the table above - Complete form, attach check and send by U.S. Mail.
  Please do not use "nick-names". Your full legal name is required for use on official documents !!!

Manuals/materials can be shared by up to 3 people.  Please list All attending

 

First Name

Mid (I)

Last Name

Phone

E-Mail Address

Birthdate
MM/DD/YYYY

1.

 

 

 

 

 

2.

 

 

 

 

 

3.

 

 

 

 

 

4.

 

 

 

 

 

3  Type in your U.S. Mail address below in case we need to mail you information: 

Mailing Address for Information and Manual(s)

Street Address or Post Office Box

City

State

ZIP

 

 

 

 

 YOUR ADDRESS IS NECESSARY !   

4   Please indicate number of students you wish to register in the form below: -one form per family, please! 

Instruction provided free by volunteers !    Cost of manual is as follows:  

      Number of manuals needed.  Up to three people can share the material                               $40.00 ea.

$  

5   Total amount submitted with application. 

TOTAL

6   Now, Print out this form with your information typed in as indicated and place in the US Mail along with your check. 

 Make check in the amount of the TOTAL above  payable to:
"Charlotte Power Squadron"
and send, along with this form, to:
CPS
 4035 Perth Road, Indian Land, SC 29707


For additional information please call:

Charles R. Ibach, (803) 396-5508
e-mail:
chasi3@aol.com

 

NOTICE !
Due to the demand for Boater Safety Education, the CPS requires 48 hour notification if you can not attend this SPECIFIC class date.  Failure to do so may result in forfeiture of your registration fee.  We will do everything possible to accommodate you at a future class.