Season Pass Application Title * Given Name(s) * Surname * Address * Address Address Address City City State State Post Code Post Code Date Of Birth * Mobile Phone * Drivers License * Email * Have you participated in an SYCBA ‘Start Crewing/Sailing Course * Yes No Australian Sailing Number You’ll find this on your last certificate if you have already completed an Australian Sailing course. Emergency Contact Name * Emergency Contact Phone Number * Relationship * Checkboxes Asthma Hepatits A Hepatitis B Diabetes Heart murmurs Epilepsy Hernia Heart problems OtherOther 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 Please provide details * Please provide details * Please provide details * How would you like to pay? Upfront Payment (Annual Fee) Payment Plan If you are human, leave this field blank. Submit
