Port2Port Yacht Rally 2010


Name of Boat:  
Preferred Email Address:
Confirm Preferred Email Address:
Alternate Email Address if any:   
Port of Departure:  
Number Of Crew  
Please provide details of all crew members including skipper.
If space is not enough, please list extras in message box. .		    
Full Name:  
Preferred Name  
Date of Birth dd/mm/yyyy:  
Nationality:  
Passport Number:  
     
Full Name:  
Preferred Name  
Date of Birth dd/mm/yyyy:  
Nationality:  
Passport Number:  
     
Full Name:  
Preferred Name  
Date of Birth dd/mm/yyyy:  
Nationality:  
Passport Number:  
     
Full Name:  
Preferred Name  
Date of Birth dd/mm/yyyy:  
Nationality:  
Passport Number:  
     
Nominated ETA Bundaberg *  
     
Registration Number of Yacht  
Registered Country of Yacht:  
Type of Yacht:

 
Length of Yacht  
Color of Hull  
Are any of the following on board: PETS:             YES   NO

FIREARMS:    YES   NO		  
Please include message if required
Include any special dietery requirements (allergies etc.) :

 

* The nominated ETA Bundaberg is for a competition only and you will not be held to the time.
To be elegible to win the competition, the time MUST be submitted before your departure.

 Please enable the following email address for correspondence and newsletters: lesfred4@dodo.com.au 

By submitting this entry form you agree to pay an entry fee of $95 per yacht. This fee should be paid either at time of registration or before 1st October, 2010. For payment details see: