To help us meet new reporting requirements of AMSEA's U.S. Coast Guard funding, we request that you furnish AMSEA with information BEFORE each cold water safety course, workshop or seminar you plan to teach.

AMSEA will use information not only to secure ongoing funding but to also serve you better.

Fill in the blanks below and click the submit button to send it to us. Click the reset button to clear the form for the next entry.

Thank you!

Pre-Course Information

Type of Course Planned:

F/V Drill Conductor
F/V Drill Conductor Refresher
Stability Awareness
Other Fishermen's Workshop - please describe below
Alaska Water Wise (AWW)
Other Recreational Boating Course - please describe below
Custom Course for a Business or Agency - please describe below
Educators/Schoolteachers Workshop for adults who work with children or teenagers - please describe below
Course for Children and/or Teenagers (anyone 18 or under) - please describe below
Other - please describe below

Brief course description:

Number of hours of instruction to be provided:

Estimated number of adults who will attend:

Estimated number of children who will attend:

Will this course include immersion suit use? Yes No

Dates: (mm/dd/yyyy)
Start:     End:

Name of the organization, school, business or other group for which you will provide this course:

City where the course will be held:

State:

Instructor Information

Primary Instructor Name:

Additional Instructor Name(s):

Is support from AMSEA needed for this class? If yes, please describe:

This pre-course form submitted by:

E-mail Address:

Phone:

THANK YOU!

AMSEA's course coordination staff will contact you shortly to provide any assistance needed with this class.