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Schedule a Boating Safety Education Course
Complete this form to have a boating safety course added to the calendar section of the Commission's web site.
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* Required fields
If yes is selected for "Open to the Public?" all data entered is included with the web calendar listing
COURSE*
  PA Basic Boating   US Power Squadron
  Boating and Water Safety Awareness   USCG Auxiliary
        US Power Squadron/USCG Auxiliary - provide course name
CONTACT INFORMATION
Name
E-mail address
Telephone (xxx-xxx-xxxx)
Extension
COURSE DATES & TIMES
Select Option 1 OR Option 2, and ONLY enter information under that option
OPTION 1
Single day, consecutive days or weekly recurring (if weekly recurring do NOT enter end date)
Date course begins
(xx-xx-xxxx)

  Date course ends
(xx-xx-xxxx)
 
Check here if weekly recurring   Number of weeks (including 1st week)
OPTION 2
Choose and complete below if course is NOT single day, consecutive days or weekly
Course dates (xx-xx-xxxx)
Date 1
Date 2
Date 3
Date 4
Date 5
Date 6
Date 7
Date 8
Date 9
Date 10
FOR BOTH OPTION 1 & 2
If times vary enter an explanation in Additional Information box under Course Information below
 
Start time
a.m.
p.m.
   
End time
a.m.
p.m.
NOTE: Enter time as 1-12 only, no military time or text.
COURSE INFORMATION
Lead instructor first name
Lead instructor last name
PFBC instructor ID# for lead instructor
Location
Street address
City*
State
Zip code
County*
Sponsoring Organization
 
Web site (include http:// or https://) for more information (leave blank if none)
Open to the Public?*   Yes
    No
Pre-registration required?   Yes
    No
Fee, if any
$
Additional information about the course

A confirmation message will be sent to the email address provided.
After submitting this form you will be taken to the PFBC home page.