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:

We will contact you shortly for your payment information. Please confirm that your phone and email contact information is correct.

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 ?