Name of Yacht
Crew Details
Crew First Name
Crew Last Name
Crew Street Address
Crew Address (cont.)
Crew City/Suburb
Crew State
Crew Post Code
Crew Phone, home
Crew Phone, work
Crew Mobile
Crew Email Address
Crew Personal EPIRB Hex Code Number
Role on boat	Skipper Owner Watch Captain Navigator Helmsman Crew Cook Radio Operator
Sailing Experience
Any Medical condition needing awareness of ?
Doctor Name and Contact details ?
Please Note:  ALL nominated “Next of Kin” (NOK) or friend must be Shore-Based during the event or series. • One NOK MUST be nominated as Shore-Based Yacht Rep for the race.  • For efficiency, any race news and emergency information will be forwarded to the ”Yacht Rep” • The vessel “Yacht Rep” must receive a copy of these details so they can on-forward any news to all other Next Of Kin.
Next of Kin (NOK) Details
NOK - First Name
NOK - Last Name
NOK Relationship    (NOK is the...	Wife Husband Partner Father Mother Brother Sister Son Daughter Friend of the Crew Member.
NOK - Street Address
NOK - Address (cont.)
NOK - City/Suburb
NOK - State
NOK - Post Code
NOK - Phone, home
NOK - Phone, work
NOK - Mobile
NOK - Email Address
NOK will act as "Yacht Rep"	Yes No
Declaration
As a crew member, I agree to be bound by the rules and conditions of the race. I agree to indemnify the Multihull Yacht Club of Queensland, associated Yacht Clubs and the event organizers from all liability whatsoever arising from my participation in the event.
By submitting this form, I hereby agree to these conditions	Yes No