RIPPLE ROCK SQUADRON

PO BOX 481

CAMPBELL RIVER, BC V9W 5C1

Contact Ed Falstrem at 250-923-3333 (W) or 250-923-7398(H) for more information.

BOATING COURSE APPLICATION FORM

Effective July 1, 2007, the cost for the Boating Course is $250.00 per person or $350.00 for a couple. (Two people within the same family). Please download the form, fill in the details, and enclose a cheque, made out to Ripple Rock Squadron and mail to the Squadron Training Officer at the above address. Please note that this fee includes, upon successful completion of the course exam, a one year membership in the Canadian Power Squadron.

This application is for the next: [ ] Fall Boating Class. [ ] Spring Boating Class.

PLEASE PRINT

Mr. Mrs. Ms.

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

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 the location for the Boating Course you have chosen to attend.

Thank you

Ed Falstrem

Training Officer

Ripple Rock Squadron and CPS recognize 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 website at www.ripplerocksquadron.com to view our complete Privacy Policy. Price of the course is subject to change without notice.