RIPPLE ROCK SQUADRON

PO BOX 481

CAMPBELL RIVER, BC V9W 5C1

Contact Ed Falstrem at 923-3333(W) or 923-7398(H) for more information.

MARITIME RADIO SEMINAR (VHF) COURSE APPLICATION

This course is composed of two modules: The first module is a basic Marine Radio Seminar; the second module

is a complete DSC & GMDSS seminar. Students passing the requisite examination will now be certified for

ROC(M) with a DSC endorsement.  People already with an ROC(M) will be able to take the DCS/GMDSS Module 2 and a specific shorter exam to upgrade their certification from ROC(M) to ROC(M) with DSC.

[   ]      For the two Module full seminar the cost is $70.00.

    [   ]      For the Module 2 upgrade seminar the cost is $35.00.

Please download the form, fill in the details, indicating which seminar you wish to take, enclose a cheque made out to Ripple Rock Squadron and mail to the Squadron Training Officer at the above address.

            PLEASE PRINT

Mr.  Mrs.  Ms.

            Given Name: ...........................................................Family Name: ..............................................................

            Address: ......................................................................................

            City: ............................................................................................

            Postal Code: ................................Phone No: ..............................Email Address…………………………..

Upon Receipt of your application and payment, you will be notified by phone regarding the exact starting

date and location for the VHF Maritime Radiotelephone Course you have chosen to attend.

                                                                                                                                                            Thank you.

Ed Falstrem

Training Officer

Ripple Rock Squadron and CPS recognise the importance of a person’s privacy and the sensitivity of personal information, such as their name, address and

phone number.  Ripple Rock Squadron will only use personal information for the purpose it was originally collected except with the consent of the

individual or as required by law.  We will destroy or erase documents containing personal information, as soon as it is reasonable to assume that the original

purpose is no longer being served by the retention of the information  Please visit our web site at www.ripplerocksquadron.com to view our complete

Privacy  Policy.