Please complete ALL fields on both pages by clicking or tabbing through the grey boxes and typing in the required details. Print off, sign and return to: John Miller, 70 Park Avenue, Birchington, Kent CT7 0DL together with your payment.
Full Name:
Address:
Tel: Mobile: Email:
I enclose my Click to Select* of £ for a berth from (Date)
To (Date) for (Course/Berth): Click to Select *
Cheques should be made payable to CSSA-ECYD. The final payment is due six weeks before sailing.
ECYD does not normally refund berth fees, although they may be carried forward to another trip.
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We strongly recommend that you take out holiday insurance to cover any eventualities.
CSSA Membership (all sailors must have membership)
Membership number Membership Type Click to Select *
N.B. Day membership is limited to 14 days in a 12 month period, and cannot be repeated.
For some berths or courses some previous experience is necessary. Please confirm your eligibility for the course/berth requested by giving on page 2, details of your previous experience including miles logged and shore-based/ practical courses completed.
HEALTH DECLARATION – To be completed for ALL applications
Details of any medical treatment being received (if none write NONE).
1. I declare that to the best of my knowledge I am not suffering from Epilepsy, Disability,
Diabetes, giddy spells, Asthma or Heart condition and that I am fit to participate in the course*
Signed ………………………………………………… Date
2. I am unable to sign the declaration but I have discussed my situation with the Crew Secretary and the Instructor is happy for me to participate on the course*
Signed ……………………………………………… Date
* Click box to select answer.
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See bottom of page 2.
More information is available on our website www.ecyd.org.uk
. Email cruising@ecyd.org.uk
or Tel: 01843 845934
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Previous Experience:
Miles logged tidal
Miles logged non-tidal
Night hours
Practical courses
Shorebased courses
Other courses e.g. GMDSS
Brief General Experience:
Shore Contact Details: (for emergency use whilst you are on board).
Name:
Address:
Telephone Number: Day Evening Mobile
Relationship:
Signed: ……………………………………………………
Name:
Date:
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No refunds are made unless the berth is re-let. Any refund will be reduced by £15 to cover administration costs.
The ECYD reserves the right to vary these conditions at the discretion of the committee.
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