Fill in the Boxes Below if You are Booking For A National Governing Body Course.

Name Telephone Contact Date of application e-mail

Address

Course Required Course Type Sailing Level One Sailing Level Two Powerboat Level Two BCU One Star Date Required Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month January February March April May June July August September October November December Year 2005 2006 2007 2008 2009 2010

Do You Have Any Medical Conditions That We Should Be Aware .Please indicate

Age if Under (18) Parental Permission If Under (18) Please sign with Parent Name

How far can you swim Below 10mtrs 10mtrs - 25mtrs Over 25mtrs

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