Please provide the following contact information:

First name
Last name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail

Course Desired

Sailing 101 Sailing 103 Sailing 101 & 103 Combo

Sailing 104 Sailing 105 Sailing 103 & 104 Combo

Prior ASA Certification

Yes No

Current Certification Level:

Preferred Dates for Class: 

Number of People:    1 2 3 4

Names:

Enter of Amount of Deposit

Method of Payment:

Check Money Order Credit Card

Enter Type of Credit Card - Visa, MasterCard, or Discover

Enter your credit card number:                      Expiration

Call me by phone for card number.

You may fax (231) 755-1522 this form or call (231)
759-8596 as an alternative order method.

Will you stay on boat overnight ?
Yes             No

What time and date will you arrive ?