Seminar Registration Form

If you are would like to preregister for a seminar just fill in the form below and submit it. If you have any questions about a seminar you can direct your question to our the ASEO, Fred Taylor. Remember all seminars start at 6:15pm with the exception of the March 25th, Trailering Seminar at Boater's World which starts at 5:45pm.

I am registering for

Last Name:*
First Name:*	(include middle initial, if desired)
Street Address:*
City:*	State: Zip: - County
Phone:
Email:*
A valid email address is important for us to be able to communicate with students prior to and during the class. The address you supply WILL NOT be used for any other purpose.- indicates a required field.
Member Certificate # or, please enter the last 4 digits of your SSN:
(The above information is required for credit towards certification. Please be sure it is accurate)
Questions/Comments:

Male Female Birth State:
BOAT TYPE: None Outboard I/O Inboard SAIL PWC Paddle
BOAT LENGTH: Under 16' 16 - 25 26 - 39 40 -54 55 UP
DO YOU TRAILER YOUR BOAT? Yes No YEARS BOATING:
HOW DID YOU LEARN ABOUT THIS COURSE? CHECK ALL THAT APPLY.
Magazine Shopper Newspaper Website TV Radio Poster/Flyer Other
Name or Description of source(s):