APPLICATION FOR A PERMANENT
PENNSYLVANIA BOATING SAFETY EDUCATION CERTIFICATE
Rev: 6.2017
(Discover / MasterCard / Visa)
Applicant’s Signature or Parental Signature if Applicant is Younger than 18 Years of Age
Please check the appropriate box and follow the instructions below.
TEMPORARY to PERMANENT ($10) – To convert a temporary PFBC (PA Fish & Boat Commission) certificate
to a permanent certificate, submit this form, a copy of your temporary certificate, and payment.
DUPLICATE or REPLACEMENT ($5) – To apply for a duplicate or replacement PFBC certificate, submit this form
and payment. (This selection is only for persons who have previously been issued permanent PFBC certificates).
OTHER CERTIFICATIONS ($10) – To convert a U.S. Coast Guard Auxiliary, U.S. Power Squadron, or other
course approved by the National Association of State Boating Law Administrators (NASBLA) to a PFBC
Boating Safety Education Certificate, submit this form, your current certificate, and payment. Include a self-
addressed, stamped envelope if you want your current certificate returned.
Processing and delivery of permanent cards may take 30 to 40 days. Should you not receive a permanent card
within that time frame, contact the PFBC immediately at 888-723-4741. Please note that temporary PFBC Boating
Safety Education Certificates are valid for only 60 days from the date of issue.
CURRENT INFORMATION (Please PRINT)
PA Certificate No.
(Leave blank if not known)
MAILING ADDRESS
Street or P.O. Box No.
City: State: Zip Code:
PLEASE CHECK “” THE APPROPRIATE SELECTION IN EACH COLUMN
(choose only one each)
Number of Certificates Ordered: ______________ Payment: $_______________ (Do Not Send Cash)
Check or Money Order #_______________________________ (Payable to PA Fish & Boat Commission)
Credit Card # _______________________________________________ Exp. Date (ex. 04/2017) _________________
Mail to: PA Fish & Boat Commission
Boating Safety Education
PO Box 67000
Harrisburg, PA 17106-7000
I hereby certify, under penalty of law, that the foregoing information is true and correct to the best of
my knowledge, information and belief. I understand that submission of false information in
connection with this official application may be subject to criminal penalties under 18 Pa. C.S. Ch. 49
and 30 PA. C.S. Ch. 9.
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