Basic Safety Training for Fishers Registration - WASH Lifeguard Certifications

Seamanship Registration

Name of Registrant and/or Representative Completing this Form

First Name

Last Name

Registrant Email Address

WhatsApp #

Other Phone #

Government Ministry/Organization Name/Affiliation:

Mailing Address

City

State/Province

Zip/Postal

Country

Mailing Address

Shipping Address (only if different from Mailing Address)

City

State/Province

Zip/Postal

Country

Shipping Address (only if different from Mailing Address)

# of Participants

ENTER PARTICIPANTS’ INFORMATION (unless same as person completing this form)

Participant Name (only if different from person completing this form)

First Name

Last Name

WhatsApp # (only of different from person completing this form)

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Billing First Name

Billing Last Name

Billing Street Address

Billing Street Address Line 2

Billing City

Billing State/Province

Billing Zip/Postal

Billing Country

Agree to Payment and Payment Terms:

I and/or my Organization hereby agrees to all World Academy of Safety & Health (WASH) International Privacy Policy & Terms & Conditions

I and/or my Organization hereby authorize(s) World Academy of Safety & Health (WASH) International to send an invoice for the tuition amount due for registration and enrollment in the STCW Basic Safety Course and/or the STCW Train the Trainer course (at the location selected above) and to process and charge my credit/debit card(s) the total tuition due to finalize enrollment. I confirm that the information within I have listed on this form for billing address is complete and accurate. I have been informed that I waive my right to dispute the charges and/or to initiate a chargeback assuming the amount charged matches the tuition amount publicly advertised for course enrollment.

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