APPLICATION FOR EASTERN SHORE SMALL CRAFT INSTITUTE June 8 - 10, 2001

Fill out this form, print it, get doctor's signature, and mail with registration fee of $205 before June 1, 2001.

Eastern Shore Small Craft Institute
440 Polly Drummond Hill Road
Newark, Delaware 19711


Name
AddressStreet
Adress2City State Zip:
(area code) Phone
E-mail (optional)
PersonalAge Sex: Female Male
Current Red Cross certificate held
Enrollment
  • first choice
  • second choice
Comments
Map needed
Doctor's Signature This applicant is physically fit to engage in strenuous aquatic activities.


leave these fields blank

Application Received _________________
Fee Paid _____________________________
______ check ______ M.O. ______ cash
Acceptance Mailed ____________________
Registration Complete ________________


Registrations should be made as soon as possible as they are honored in order of receipt. All courses are limited. The fee must accompany this application. There will be a $30 fee charged for all cancellations. No refunds after May 28. Make checks payable to Eastern Shore Small Craft Institute.