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SKIPPERS TICKET BOOKING FORM
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COURSE
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Course
$178 ea STANDARD Theory & Practical course
$119 ea Practical only (done Theory elsewhere)
$169 ea STANDARD Group (3+) discount
$249 ea FULL BEGINNER COURSE
$199 ea FULL BEGINNER GROUP (3+) discount
$ Price Match (tell us what to match and we will)
$400 Family (of 3) Special
$99 Saturday Assessment only (no training)
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Boat
Choose Boat
Students Own Boat
Trainers Boat ($20 extra)
TIME AND PLACE
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Boat Ramp
----- PLEASE CHOOSE -----
Bassendean (Pickering Park)
Belmont (Abernethy Road)
Belmont Ski area - use Maylands
Bunbury
Busselton
Coogee
Dampier / Karratha
Dunsborough
East Fremantle (Leeuwin)
Hillarys
Mandurah Area, Dawesville (South of Channel) Boat
Mandurah Area, Mary Street
Mandurah Area, Waterside Canals
Mandurah Area, Yanderup Canals
Mandurah Marina
Margaret River
Matilda Bay (Hackett drive)
Maylands
Murray River Nrth Yunderup Cullenup Road
Murray River, Murray Lakes Canals
Murray River, Sth Yunderup (River Road)
Woodman Point
Or other place
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Date of training
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January
February
March
April
May
June
July
August
September
October
November
December
2012
2013
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Time
Anytime is ok
Morning preferred
Afternoon preferred
8am
10am
12
2pm
4pm
Other
When?
STUDENT DETAILS
Student names and numbers can be changed later if needed, this is only a guide to assist us calculate how much time you may need.
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#of people
1
Please enter details for each student below:
Detail for student#
1
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Surname
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First name
Other name
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Mobile
Phone (H)
Phone (Wk)
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Email
Driving licence#
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Age
Select
Over 18
14 to 18
Under 14
Residential Address:
St. #
St Name
Suffix
Suburb
P/code
State
Postal Address:
P.O. Box
Suburb
P/code
State
Notes
OTHER DETAILS
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How did you hear about us?
Quokka
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Dept Transport
MSN
Live
Bumper Sticker
Other
