EOEEA-MEP

Last Name(Required)

First Name(Required)

Middle Initial

Date of Birth(Required)

Hair Color(Required)

Eye Color(Required)

Gender

Male

Female

Under Age 16

Yes

If under Age 16, Enter Name of Parent or Legal Guardian

Note: If the student is under age 16, a parent or guardian must attend this course with the student.

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email Address(Required)

Please enter the Class ID for the class you wish to attend.(Required)

Class ID from the Boating Safety Course Listing

Boat and Recreation Vehicle Safety Bureau
PO Box 1325
Forestdale, MA 02644

Phone: (508) 564-4961

FAX: (508) 564-4964