www.force67.com
(914) 629-0787
Registration form for AMERICA’S BOATING COURSE and PERSONAL WATER CRAFT
Last Name: First Name:
Address:
City: State: NY NJ CT MA VT PA DE Zip:
Telephone: Email:
Birthday: Gender: Male Female
I own a boat I own a Jet Ski
I’d like to be informed of future boating courses and events.
How did you find out about this course? Flyer Website Friend TV Newspaper Marine Dealer Boat show Other
Are you a student? Yes No If “Yes” where do you go to school? What year of school are you in? 6th - 8th grade 9th-12th grade College Grad. School
Are you currently a member of the US Coast Guard Auxiliary? Yes No
If “Yes” which Flotilla?
Use your browser to print out this page.
ABC (includes PWC) $75 Total Amount Enclosed
$ ___________
Please make check payable to: USCGAUX Flotilla 67
Mail form Don Elmendorf, VFC P.O. Box 273 Millwood, NY 10510 dreenviro@msn.com