2017/18 Australian 16ft Skiff Championship Entry

Boat Name(*)
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Sail Ensign(*)
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Registration No - Hull(*)
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Skipper Name(*)
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Club
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If Club chosen is "other" please type Name of Club
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Skipper Date Of Birth(*)
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Street Address(*)
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Suburb(*)
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State(*)
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Postcode(*)
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Mobile(*)
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Email(*)
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SA Number(*)
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Crew 1 Name(*)
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Crew 1 Club
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If Club chosen is "other" please type Name of Club
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Crew 1 Date of Birth(*)
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Street Address(*)
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Suburb(*)
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State(*)
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Postcode(*)
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Mobile(*)
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Email(*)
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Crew 1 SA Number(*)
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Crew 2 Name(*)
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Crew 2 Club
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If Club chosen is "other" please type Name of Club
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Crew 2 Date of Birth(*)
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Street Address(*)
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Suburb(*)
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State(*)
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Postcode(*)
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Mobile(*)
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Email(*)
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SA Number(*)
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Declaration
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(*)
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Declaration Skipper or Owner Name (*)
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Declaration Date(*)

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Entry Fee

Up until the 11 December 2017 the entry fee will be $350. After the 11 December 2017 a late fee of $100 will be incurred, therefore entry fee will total $450.

Total
0.00 AUD

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