BOOKING FORM
Title
Mr
Mrs
Miss
Ms
Dr
Rev
First Name:
Surname:
Postal Address including postcode:
email address:
Telephone [Home]:
Telephone [Work]:
Fax Number:
Telephone [Mobile]:
Age:
Occupation:
RYA Certificates Held
Course / Exam Required
Novice
Competent Crew - practical
Day Skipper - shorebased
Day Skipper - practical
Coastal Skipper/Yachtmaster offshore - shorebased
Coastal Skipper - practical
Coastal Skipper - RYA/DoT practical examination
Yachtmaster Offshore - RYA/DoT practical examination
Yachtmaster Ocean - shorebased
Yachmaster Ocean - practical
Yachmaster Ocean - RYA/DoT oral examination
Yachmaster Ocean -
Preferred Dates:
Dietary Requirements:
Details of any medical treatment being received (if none, write "none")
I declare that to the best of my knowledge I am not suffering from epilepsy, disability, giddy spells. asthma, diabetes, angina, or other heart condition, and am fit to participate in the course.