MIAMI SAILING CLUB

Course Registration Form

 

  • Please provide the following contact information:

    • First name

    		 Spouse

    Last name

    		 Children

    Street address

    City

    State/Province

    Zip/Postal code

    Occupation

    Employment or business name

    Work Address

    Zip/Postal code

    Work Phone

    FAX

    Home Phone

    Cell. Phone

    E-mail

    Birth date

    Driver's License #

    Can you swim?

    Have you sailed before?

    :

    		  
    Previous sailing experience: type of boat
    Favorite sports
    Help us: How did you find out about MISS?
    Do you suffer from any serious illness (confidential)?
    Do you own a boat? Describe
    Did you own a boat? Describe
    Do you plan to buy a boat? Describe
    Indicate type of course in which you wish to enroll
    Indicate approximate date you wish to start
    Observations / Special requirements

     

    Check number
    Bank
    Credit card
    Account number
    Expiration date
    Billing zip code

    User name

    		(if desired)

    Password

    		(if desired)

    Confirm password

    		(if desired)

     

    Reservation for how many ?

                                                        Enter the date : -- mm/dd/yy