DOWN SOUTH APPLICATION

PLEASE PRINT CLEARLY (fill in after printing this form out on your printer)

Name: _______________________________________________________________________

Cabin Mate Name: ______________________________________________________________

*Please print your first & last name as they appear on your passport! This is how your plane ticket

 will be booked.  Please also list the name you use regularly if different from passport.

Address: ______________________________________________________________________

City: ____________________________   State: ______________  Zip Code: _________________

Phone Numbers:            (home) _________________________     (work) ____________________

                                    (Cell) ___________________________   

Email: _________________________________    Email: _________________________________

Please enroll me in:       Learn to Cruise: Feb 14-21          Feb 21-28          Feb 28-Mar 7 for 2009

                                    Level:                ASA 103           ASA 104

                                    Flotilla:              Feb 19-28, 2009

Pricing:                         Single / Couple $ __________________________

Do you plan to purchase “Trip Insurance” for an additional fee?       YES     NO

(Fee must be paid when flight is booked.)

Date of Birth: (mm/dd/yy) _________________     Date of Birth: (mm/dd/yy) __________________

Deposit:            Check               VISA                 MasterCard       Cash

Credit Card # ______________________________________________

Expiration Date ________________         Security Code (last 3 digits near signature) _________

Administration

How did you find out about programs being offered down south? __________________________

Booking & Payment

Please enclose this completed form (both sides) along with a check or Visa/MC number for 50%

made out to Nelson Sailing Center, to reserve your place.

Balance is due November 5, 2008.

Remember Our Cancellation Policy

·         $500 penalty for cancellation up to 90 - 61 days prior to departure date.

·         75% penalty for cancellation 46 - 60 days prior to departure date.

·         100% penalty for cancellation within 45 days prior to departure date.

_____________________________________________                 ______________________

Signature                                                                                  Date                (Continue to Page 2)

Sailing Experience – Required for the Flotilla Participants

Have you sailing before? (Circle one)        YES     NO

If yes,   a) confidence level (Circle one)    STRONG           MEDIUM           WEAK

            b) BIG BOAT (28’ & over) or SMALL BOAT (under 28’) or BOTH

            c) As    SKIPPER          or         CREW              or         BOTH

            d) Have you owned a boat?         YES     NO       What type? ________________

Do you hold ASA or US Sailing certification?

            What level: _____________________________________________

Have you ever chartered a boat before?    YES     NO

            If yes, what company: _____________________________

                        What size of vessel: ________________________

                        Location: _________________________________

Would you be willing to skipper a boat during the Flotilla? YES     NO

Other sailing/racing experience?

_____________________________________________________________________________

_____________________________________________________________________________

Do you have any related experiences you feel we should know about? I.e. Navigation/Navy/Pilot

____________________________________________________________________________

_____________________________________________________________________________

Are you a certified scuba diver?               YES     NO

Would you be interested in an organized dive trip or two during the Flotilla?             YES     NO      

Nelson Sailing Center, 12 Lake Dr, PO Box 386, Island Heights, NJ 08732

732-270-6510 ~ nelsonsailing@comcast.net ~ www.nelsonsailingcenter.com