Warning: This course is currently booked-out. You may fill-in the form below if you wish to be placed on a waiting-list; we will notify you if - and when - a place becomes available. Selected Course: Tackers 2 - After School Program Sessions: Wednesday 6th February, 4:15 pm - 6:00 pm Wednesday 13th February, 4:15 pm - 6:00 pm Wednesday 20th February, 4:15 pm - 6:00 pm Wednesday 27th February, 4:15 pm - 6:00 pm Wednesday 6th March, 4:15 pm - 6:00 pm Wednesday 13th March, 4:15 pm - 6:00 pm Wednesday 20th March, 4:15 pm - 6:00 pm Wednesday 27th March, 4:15 pm - 6:00 pm Price: $365.00 SYC Member Price: $365.00 Participant Details First Name: * Last Name: * Date of Birth: dd01020304050607080910111213141516171819202122232425262728293031mmJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberyyyy2024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901 Gender Female Male Other (PH) Home: (PH) Mobile: * Email Address: * Street Address: * Suburb / Town: * Postcode: * State: ACT New South Wales Northern Territory Outside Australia Queensland South Australia Tasmania Victoria Western Australia Referrer: -- Australian Sailing Course Finder Bayside Directory Friend/Relative Internet Other Previous Participant School Group School Newsletter SYC Member SYC Website Australian Sailing Number: Click here to search for your AS number Medical Details Emergency Contact: Emergency Contact (PH): Do you have or had any of the following conditions: Asthma Hepatitis B Heart murmurs Epilepsy Diabetes Hernia Hepatitis A Heart Problems Other Do you have any allergies? No Yes: Do you take regular medication? No Yes: Have you had a serious injury in the last five years? No Yes:
