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U.S. Coast Guard Auxiliary Logo

United States Coast Guard Auxiliary
First District Northern Region
Maine, New Hampshire, Massachusetts & Rhode Island

 First District Northern Logo

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D1NR Internet PE Advertisement Request
(Use this form for entering more than one class)

[Go to Single Entry Form]
 

I request that the following PE courses be posted on the D1NR Web Site
Contact Information for Individual Submitting this Form
PE Officer's Name: 
PE Officer's Email Address:

 

1

 Flotilla Number:  District: 013  Division:   Flotilla:
Course Type:
Location(City/Town & State):
Start Date:
Course Telephone Contact:
Course E-mail Contact:
Website:

 

2

 Flotilla Number:  District: 013  Division:   Flotilla:
Course Type:
Location(City/Town & State):
Start Date:
Course Telephone Contact:
Course E-mail Contact:
Website:

 

3

 Flotilla Number:  District: 013  Division:   Flotilla:
Course Type:
Location(City/Town & State):
Start Date:
Course Telephone Contact:
Course E-mail Contact:
Website:

 

4

 Flotilla Number:  District: 013  Division:   Flotilla:
Course Type:
Location(City/Town & State):
Start Date:
Course Telephone Contact:
Course E-mail Contact:
Website:

 

5

 Flotilla Number:  District: 013  Division:   Flotilla:
Course Type:
Location(City/Town & State):
Start Date:
Course Telephone Contact:
Course E-mail Contact:
Website:

 

By submitting this form, I am aware that personal information (telephone number and email address) will be posted on a web site available to anyone with internet access and that I am authorized to release this information.

 

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