2017 Training - Online Booking

Please enter Student's Details here

Course Type:
If "Other" is selected, please specify:

Preferred Dates:
Student's Name:
* Required *
Contact Email:
* Required *
Student's Address:
Mobile Number:
Land Line:
Previous Experience:
Swimming Ability:
Any Medical Conditions:
Date of Birth:
CBC Club Member:
(Yes or No)

Please enter Parent / Guardian Details here (if student is over 18 enter Next of Kin)

Parent / Guardian / Next of Kin Name:
* Required *
Postal Address:
Mobile No:
Home Number:
Shore contact while in Clifden:

Cheques payable to: Clifden Boat Club

Cheques, with printed form, can be posted to: Paul Passemard, Sky Road, Clifden, Co. Galway

You can also pay by "Pay Pal".
You will be emailed confirmation of availability and paypal details on receipt of this online booking.