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
.
* 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
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Other
Zip code
County*
Choose a county
============
Adams
Allegheny
Armstrong
Beaver
Bedford
Berks
Blair
Bradford
Bucks
Butler
Cambria
Cameron
Carbon
Centre
Chester
Clarion
Clearfield
Clinton
Columbia
Crawford
Cumberland
Dauphin
Delaware
Elk
Erie
Fayette
Forest
Franklin
Fulton
Greene
Huntingdon
Indiana
Jefferson
Juniata
Lackawanna
Lancaster
Lawrence
Lebanon
Lehigh
Luzerne
Lycoming
McKean
Mercer
Mifflin
Monroe
Montgomery
Montour
Northampton
Northumberland
Perry
Philadelphia
Pike
Potter
Schuylkill
Snyder
Somerset
Sullivan
Susquehanna
Tioga
Union
Venango
Warren
Washington
Wayne
Westmoreland
Wyoming
York
Out of State
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.