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United States Coast Guard Auxiliary
       
Flotilla 14-04, Jacksonville Beach, Florida
Boat America – Registration
Class Date:    

Name: __________________________________________________________                                                  First                 Middle name or initial                                  Last                                                        Note: use the name on a government issued ID; school or driver’s license.

Street Address: ___________________________________________________

City: ____________________County: ________State: _______ZIP: ___________

 

Telephone #: __________________Email: _______________________________

DOB (MM/DD/YYYY): _______________________ (required for Boater Card)

Prior Boating Class? Type: __________________When: ___________________

Do you own a boat? Type/Make: _____________    Age/Length: _____________ Boating Experience
(Years): ___________________Children/Ages: __________

Would you like a complimentary Vessel Safety Check?

___________________
Program Cost is $25.00 per participant; two can share materials.
Parents must attend with minor children.
Please make checks payable to: Flotilla 14-04
Upon completion of the course and passing the final exam, you will be issued a temporary card. The official FWC Boater Card will be mailed within 3 to 4 weeks.
To confirm reservation and to arrange payment, please contact:
Bill Hurlburt - 904-200-9409; boatsafely04@outlook.com
United States Coast Guard Auxiliary
Flotilla 14-04, Jacksonville Beach, Florida