Pacific Coast and Pollock EM Program Registration Form

Early-registration pricing is in effect until Monday, March 4th, 2024.

Please make sure you submit your information on both of the following pages. Page one is for your vessel and permit information, page two is for your fee payment. Your registration will be incomplete if we do not receive both your vessel details and your payment.

Programs to Register with:*
Vessel Information
Vessel name*
Vessel E-mail address*
Vessel telephone number(s)*
US Coast Guard number*
Permit Holder Information
Permit Number*
Name*
First Last
Address*
Zip*
Phone*
Email*
Confirm*
- I hereby certify that I am the Permit Holder, or authorized signatory for the Permit Holder. I further certify that I have read, understand and accept the Standard Terms and Conditions, and Fee Schedule included in your registration package. I agree to be personally responsible for the payment of any and all fees for the vessel and in respect of any required equipment, licenses, permits and consents.
Primary Vessel Contact (e.g. Captain)
Name*
First Last
Address*
Zip*
Phone*
Email*
CAPTCHA

Vessel Information

Permit Holder Information

Primary Vessel Contact (e.g. Captain)