Sail Number*

Boat Name*

Home Sailing Club*

Insurance Reference Number*

Division*

Skipper Full Name*

Skipper Date of Birth*

Skipper Gender*

Skipper Email*

Skipper Phone Number*

Skipper Australian Sailing Number*

Skipper Emergency Contact Full Name*

Skipper Emergency Contact Phone Number*

Skipper Allergies/Dietary Requirements

Crew Full Name*

Crew Date of Birth*

Crew Gender*

Crew Email*

Crew Phone Number*

Crew Australian Sailing Number*

Crew Emergency Contact Full Name*

Crew Emergency Contact Phone Number*

Crew Allergies/Dietary Requirment

Other Fun Facts

My Boat is Affiliated with which State Association*

Custom Tote Bags - please upload a picture of your boat or screen shot of the Nationals logo with you hull and kite coloured in*