ASA Course Request Form ASA Course Request Form You need: One form for each person registering One form for each course requested ASA Course Requested & Fee*Please, choose which course you are requesting to take. If you need to review the information on the different courses, you can click HERE. ASA 101 - $345 ASA 103 - $345 ASA 104 - $575 ASA 105 - $375 ASA 101 "Challenge" - $200 ASA 103 "Challenge" - $200 Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Member of American Sailing Association (ASA)?* Yes No ASA Member #* Sailing Experience*Please, briefly tell us about your sailing experience (# of years, type of boat(s), etc.). If you have never sailed, put N/A. Availability*When are you primarily available to take on-the-water courses? Weekdays Weekends Flexible Location Preference*Where would you prefer to take on-the-water courses? Cave Run Lake (Eastern KY) Kentucky Lake (Western KY) Other (fill out section below) Other Location Details*Please let us know a bit about the location you would like to take the courses. Total $ 0.00 Signature**** Once you have filled out this form and submitted it you will be redirected to a screen on the PayPal website to remit payment. Please follow the instructions to either sign in with an existing PayPal account, or pay directly with a debit/credit card. Δ