DOWN SOUTH APPLICATION
PLEASE PRINT CLEARLY
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 26-Mar 5 Mar
5-Mar 12 Mar 12- Mar 19 for 2010
Level: ASA 103 ASA 104
Flotilla: Feb 26 – March 8, 2010
Pricing: Single / Couple $
__________________________
Date of
Birth: (mm/dd/yy) _________________ Date of Birth: (mm/dd/yy)
__________________
Deposit: Check VISA MasterCard Cash
Credit Card
# ________________________________(if NSC has on File,
only last 4 digits reqd)
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
Balance is
due November 1, 2009.
Remember Our Cancellation Policy
·
$100
Cancellation fee per person prior to November 1, 2009
·
No
refunds for cancellation after November 1, 2009
·
Flotilla
pricing is based on a 5 boat minimum. If
minimum is not reached, an additional $500 per boat will be charged &
divided equally among each participant.
_____________________________________________ ______________________
Signature Date (continue to page 2)
Sailing Experience – Required for the
Flotilla Participants ONLY
Have you
been 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
Would you be
interested in having a paid Nanny on board to help take of your children? YES NO
732-270-6510 ~ nelsonsailing@comcast.net ~ www.nelsonsailingcenter.com