USCG Auxiliary Course Enrollment

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Email *

Boating Safety Class Enrollment

First Name (name needs to the same as on the driver's license) *

Middle Initial *

Last Name *

Street Address *

City *

County (Collier, Lee, etc.) *

State *

Zip Code *

Phone Number *

Date of Birth *

YYYY

Sex *

Male

Female

Do you Own a Boat?

Yes

Boat Make/Model

Safe Boating Course (Boat America)

Local Waters Knowledge (Monday 3/24/25, 6-8pm)

Suddenly in Command (Date to be Announced)

Paddler's Guide to Safety (Date to be Announced)

Date of Course *

YYYY

How Did You Hear About the Course? *

Poster

Auxiliary Website

Social Media (Facebook, etc.)

Individual Referral

Newspaper

Other:

Send me a copy of my responses.

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