Lifeboat Building Online Course Registration Form

(Please print this form)

Name _________________________________________________________________

Mailing Address _________________________________________________________

______________________________________________________Zip _____________

Work Phone (_____)______________________ FAX (_____)_____________________

Home or Cell Phone (_____)___________________Email________________________

$35 deposit holds your full price reservation. Confirmation is sent by email.

Cost includes materials &  followup

_______Check Attached (Make payable to: Titanic Lifeboat Academy, Inc.)

_______Name as it appears on card ____________________________________

VISA/MC number__________________________________________Exp_____/200______

Card ID# (last 3 digits on back) _____Signature:_______________________________

Mail to: 

Titanic Lifeboat Academy, 91868 Youngs River Rd, Astoria, OR 97103