Name (first and last): Mobile phone: (numbers only:no spaces, dots or dashes please) Home phone: (numbers only:no spaces, dots or dashes please) Work phone: (numbers only:no spaces, dots or dashes please) Email address: Street Address: City: State: Zip Code: We require a major credit card for ALL reservations, even if there is no amount due. This applies even if you have already purchased your lessons online. This form is not secure, however, so if you wish to keep this information separate, we suggest you enter the credit card number here and email the expiration date and security code to 3rdcoast@3rdcoastcruising.com. Credit Card number: (numbers only:no spaces, dots or dashes please) Expiration Date: Security Code: How did you hear about 3rd Coast Cruising? Have you already made your purchase? If yes, please describe how many lessons you have bought, and through which website you purchased. Schedule request (M-F at 6:30pm, Sat and Sun at 10am and 1:30): I would also be interested in: Social Cruises Private Fireworks Cruises Sailing in the Caribbean Lake Crossing Tall Ship Training Unlimited Sailing Boat Ownership Notes or special requests: (anything we need to know: limited mobility, medical issues, history of motion sickness, etc.)
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