Advanced Training Request
*** Training requests for Summer 2019 are no longer being collected in this form. If you would like to register for a training, send an email to to@nsesc.org ***
Cadet Name
*
First Name
Last Name
Cadet Rank
*
Cadet Email
example@example.com
Parent Name
*
First Name
Last Name
Parent Email
*
example@example.com
Training Name
*
Training Location
*
Training Code
Training Start Date
*
-
Month
-
Day
Year
Date
Has Cadet attended RT?
*
Yes
No
Have you read the information on the website linked to in your specific training details on Homeport (prerequisites, travel requirements, seabag list, etc)?
*
Yes
No
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Emergency Contact Alternate Phone Number
-
Area Code
Phone Number
Medical Insurance Company
Medical Insurance Policy Number
Medical Insurance Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Medical Insurance Phone Number
-
Area Code
Phone Number
Submit
Training Officer Email Address (read-only)
example@example.com
Should be Empty:
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