Boater Certification Card Request Form
Print and fill in the information requested in the form below. Send a check or money order for the appropriate amount and this completed form to the address below. Proof of successful completion of a NASBLA approved course may be required. If you completed the course with the Missouri State Water Patrol prior to 2011 or with the Missouri State Highway Patrol in 2011 or after, you may still need to provide proof. See the Boater Certification FAQ sheet for more information on card purchasing and replacement.
Card Cost: $15.00
Pay to the order of: Missouri State Highway Patrol
Mail this information to:
Missouri State Highway Patrol
Water Patrol Division
P.O Box 568
Jefferson City, MO 65102
Please Type or Print Clearly
Last Name_____________First Name_____________M.I._____
Phone# (___) _____________
Course taught by what organization_______________
Course Location and Date__________________________________
Allow up to 30 days for processing of your application and return mail.