All registrations must be confirmed by New England Maritime. Submittal of this form does not guarantee you a seat in the class of choice. We will not charge your credit card until we have confirmed space for you in the requested course/date/location.

Insert Your CONTACT INFORMATION Below
First Name:
(FULL) Middle Name:
Last Name:
Address (Street/P.O. Box):
Address (Apartment #):
City:
State:
Country:
Postal Code:
Last 4 Digits of SSN:
Cell Phone:
Alternate Phone:
Email Address:

Select Your COURSE, DATES and LOCATION Below
STEP 1 - Select a course		OUPV Charter Boat Captain Course
		Master 25/50/100 Ton Course
		Launch Tender Course
		Boating Safety Course
		Plotting Course
		CPR/First Aid Course
STEP 2 - Course Start Date	FILL IN
STEP 3 - Select Location		Hyannis Days
		Hyannis Evenings
		Marina Bay, Quincy
	FILL IN

Insert DEPOSIT PAYMENT INFORMATION Below
Select Credit Card:	Master Card Visa American Express Discover
Name On Card:
Credit Card Number:
Expiration Date:
Card Verification Number:	(A 3 digit number on the back of VISA/MC and a 3/4 digit number on the front of AMEX cards)
Credit Card Billing Address:
City:
State:
Postal Code:
I authorize New England Maritime to charge this DEPOSIT AMOUNT to my credit card.	$
Comments/Questions:

Please read the following and check ALL BOXES:

-- I meet USCG Sea Experience requirements and have no disqualifying health or court convictions that may result in my inability in obtaining a USCG License. Please contact New England Maritime to discuss any situations of concern.

-- Submission of this Online Registration will not guarantee a seat in class. Courses fill quickly. Please call New England Maritime to insure available space.

-- Submission of this Online registration form commits me the requested course, course dates and Cancellation Policy.

-- If I have not received confirmation of this Online registration form within 5 business days, I will contact New England Maritime.