8ER Web Submission Form 7023w

Notice of Intent to Teach Public Education Course

Instructions:

Enter your course's details in the form below.

The disclosure of a member's personal information is generally prohibited under the Privacy Act of 1974 UNLESS express permission is obtained from the member. All persons whose names and contact information are utilized in the connection with this form expressly authorize the dissemination and publication of the information to members of the general public. The person completing this form acknowledges that the appropriate permissions have been obtained.

Should you desire to change or cancel a class once it has been submitted, fill out the submission form and put the correction or cancellation desired in the Remarks box. The flow of that form will result in a corrected listing or cancellation within 3 working days.


Flotilla:
Course:
Start Date:		Start Time:	(24 Hour Time)
End Date:		End Time:	(24 Hour Time)
Day(s):	Sun Mon Tue Wed Thu Fri Sat
No. of Sessions
Location:
Address:
City:
State:		ZIP:
Cost:	(Optional)
Contact:
E-Mail:
Phone:	(Optional)
Remarks:
Member Submitting Information::
Office of Member submitting:
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