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NAME (Mr,Mrs,Miss): ---------------------------------------------------------------------

ADDRESS: ----------------------------------------------------------------------------------

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TELEPHONE NUMBER: --------------------------------------- AGE (if under 18):----

PLEASE BOOK ME ------------------- BERTH (S) ON THE YACHT FOR THE

COURSE COMMENCING: ----------------------------------------------------------------

THE FOLLOWING ALTERNATIVE DATES WOULD ALSO BE SUITABLE FOR ME:
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I ENCLOSE MY CHEQUE FOR £ --------------

I AM INTERESTED IN:

------- RYA COMPETENT CREW

------- RYA DAY SKIPPER

------- RYA OFFSHORE YACHTMASTER REFRESHER

Illness or medical conditions need not necessarily prevent you from taking part on a course but we would like to know if you have a problem.

I, the undersigned, have read and agree to the conditions of charter and I declare that I am fit to participate in the course.

Delete if necessary: I give permission for my son / daughter / ward to participate in the

cruise starting on ---------------------------------------------------------------------------

Signed: ------------------------------------------------------------------------------------------

Date: --------------------------------------------------------------------------------------------

Note: In the case of those under 18,this form must be signed by a parent / guardian or other person in locoparentis.