June 8 - 10, 2001 Deadline for registration: May 28 Registration Fee: $205.00
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 June 1. Make checks payable to Eastern Shore Small Craft Institute.
Name:
Street Address:
City:
State:
Zip:
Telephone (with area code):
E-mail address (optional):
Current Red Cross certificate held:
Age:
Sex:
Comments:
I wish to enroll in the following :
(give name and number)
1st choice:
2nd choice:
This applicant is physically fit to engage in strenuous aquatic activities.
________________________________________
Doctor's Signature
Request map if needed:__________
Mail to:
Eastern Shore Small Craft Institute
440 Polly Drummond Hill Road
Newark, Delaware 19711
Do not write below
Application Received _________________ Fee Paid _____________________________ ______ check ______ M.O. ______ cash Acceptance Mailed ____________________ Registration Complete ________________
This page is maintained by Karen Paffendorf. It was last updated March 3, 1999.