Name:
Address:
Town / City :
Country / State:
Post Code:
Telephone Daytime:
Telephone Evening:
Mobile:
E-mail:
Shoreside contact in case of emergency:
Course Description
Date from:
Date to:
Previous Yachting Experience:
Health: Do you suffer from epilepsy, diabetes, heart disease, asthma or similar ailment? Please specify
Special Dietary requirements:
For our marketing purposes please indicate age:
Under 18
18 to 29
30 to 39
40 to 49
50 to 59
Over 60
I have read and understood the
terms and conditions
