Renew your body, mind and spirit

     

REGISTRATION FORM

 If paying by check: mail check or money order 

Submit form online and send to address on confirmation page

Please read our cancellation/refund statement before completing registration

 

PLEASE SUBMIT ONE REGISTRATION FORM FOR EACH STUDENT
Name
Mailing Address
City
State Zip    
Email

Day Phone

(w/ area code)

In case we need to contact you for course changes or cancellations

Eve Phone 

Cell Phone
Best method of contact

Over 18 yrs of age?

  Yes         No    IF NO PLEASE FILL IN INFORMATION BELOW:

  

    PARENT NAME      

   PARENT NAME      

   AGE OF STUDENT 

Register me for this course or event.

SUBMIT SEPARATE REGISTRATIONS FOR EACH STUDENT EVEN IF REGISTERING TOGETHER.

Choose Location:     Ithaca, NY        St. Petersburg, Florida

Event Name  

Private Sailing Lesson -1 person

      Contact us by email or phone to schedule a date

     

 Suggest a date/time 

   

 

Private Sailing Lesson -2 people

 Suggest a date/time 

Name of 2nd person

 

 

 

Group Sailing Class (to be added soon)

 

 

 

  

PLEASE LIST CHEST SIZE AND/OR WEIGHT FOR LIFE VEST FITTING

SAILING CHARTER

Leisure Sailing Charter 

  

 Suggest  dates/times (give alternative dates)  

We will contact you with availability info

 

 
Can you swim? Yes       No   
Is this for yourself or is it a gift?
I am interested in the following educational opportunities:

More local courses                                   Courses in Florida

More local women's courses                Women's retreats/courses in Florida

   

Please select some of the following topics you're interested in learning more about

Sail Trim

Docking

Intro to Sailing

Maneuvering 

Knot Tying

Navigation

Heavy Weather Sailing

Man Overboard 
Lessons - my boat

Engine Basics

Electronics - GPS

Boating Safety

Couples Sailing

Single-handing  

Advanced Sailing

Anchoring

Practice Sails with instructor aboard       
 

Other topics of interest that weren't mentioned:
Other boating interests
My boat:

(Give size, make, model)
Level of Experience:
I was referred by: (Please give person's name, Website, Newspaper or Magazine)

Google  Yahoo   AOL  MSN  Ithaca Journal   Friend

Other (please fill in below)
Please give one topic you would like to focus on most.

Other comments
I have read and agree to the cancellation/refund policy Yes  No            Please read our cancellation/refund statement

Emergency Contact

(Name/ phone#)
Please indicate any medical conditions or medications you are taking.

No present medical conditions 
If medical conditions or medication were given please give Physician's name and phone

I am paying by: Online Payment  (We accept Mastercard, Visa, Discover, AmEx through PayPal ONLY)

Sending check in snail mail (If paying by Snail Mail, Click Submit Course registration below and your online form will automatically be submitted)  Then follow directions for payment info on next screen. 

  

      By clicking SUBMIT button an email will be forwarded to us with your registration information.