2017/18 NSW 16ft Skiff Association Registration Form

Club
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If Club chosen is "other" please type Name of Club
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Skiff Name(*)
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Sail Ensign(*)
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Upload Diagram of Mainsail Ensign
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Registration No - Hull(*)
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Owner Name(*)
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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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Skipper Name(*)
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Skipper Date of Birth(*)
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DD/MM/YYYY

Skipper Mobile(*)
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Skipper Email(*)
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Skipper AS Number
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Crew 2 Name(*)
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Crew 2 Date of Birth(*)
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DD/MM/YYYY

Crew 2 Mobile(*)
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Crew 2 Email
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Crew 2 AS Number
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Crew 3 Name(*)
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Crew 3 Date of Birth(*)
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DD/MM/YYYY

Crew 3 Mobile
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Crew 3 Email
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Crew 3 AS Number
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Crew 4 Name
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Crew 4 Date of Birth
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DD/MM/YYYY

Crew 4 Mobile
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Crew 4 Email
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Crew 4 AS Number
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Crew 5 Name
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Crew 5 Date of Birth
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DD/MM/YYYY

Crew 5 Mobile
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Crew 5 Email
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Crew 5 AS Number
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I acknowledge that the club nominated above is the “home“ club of my skiff for the purposes of rule 3.4 of the “Conduct of 16ft Sailing in New South Wales” rules and that the skiff complies with all rules specified in the “Class Rules” of the Australian 16ft Skiff Association.
(*)
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Declaration Skipper or Owner Name (*)
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