Missouri State Water Patrol Water Safety Education Class Information Media Information Release Regatta Information Personnel Information Listing of other Missouri Department of Public Safety Agencies Links related to Water Safety and Water Patrol

Print and fill in the information requested in the form below. Send in a check or money order for the appropriate amount, this completed form and proof of successful completion of a NASBLA approved course. If you took the course with the Missouri State Water Patrol, you may still need the proof. See the Boater Certification FAQ sheet for more information on card purchasing and replacement.

Card Costs: New Card - $15.00, Replacement Card - $10.00

Mail this information to:

Missouri State Water Patrol
PO Box 1116
Jefferson City, MO 65102

Boater Certification Card Request Form
Please Type or Print Clearly


Last Name________________________ First Name_________________ M.I._______

Street Address___________________________________________________________

City_________________________________ State______________ Zip Code________

DOB_______________Gender_________Check #______________________________

Phone # (_____)______________ Course taught by what organization________________

Course Location and Date__________________________________________________

Allow up to 30 days for processing of your application and return mail.