First name*

 Last name*

 Address*

 City*

 Province/state*

 Country*

 Postal code/zip*

 Email address*

Please include your area code and or country code with all phone/fax numbers.

Home phone*

Work phone

ext.

Cell phone

Fax

Gender

Male   Female

Birth year

(if a minor)

Preferred language

English French

Other comments

*

 I am a local companion and can offer a billet to an out-of-town competitor.
Yes   No

 I will be staying at

Hotel/motel
/other name

Phone number

Number of others
in your party

 These qualifications are not mandatory to be a Sailing Companion, but this information  would be helpful to the Organizing Committee.

Certification(s)

NoneCPR certificationFirst Aid certificationPhysical / Occupational TherapistRegistered NurseMedical Doctor

I am physically able to transfer sailors in and out of boats

CYA Regatta Management Experience

Choose one...NoneLevel 1Level 2Level 3

CYA Instructor Certification

Choose one...NoneGreen (1)Blue (2)Red (3)Orange (4)IE

CYA Keelboat Standard Certification(s)

NoneCompetent CrewBasic CruisingIntermediate CruisingAdvanced CruisingOffshore CruisingBasic Keelboat RacingCostal NavigationAdvanced NavigationCelestial Navigation

CYA Powerboat Standard Certification(s)

NoneBasic OutboardBasic PowerboatIntermediate Powerboat

Tell us a bit about your experience (types of boats, years sailing, etc.)

 A Salmon Barbecue will be held Tuesday, Sept. 12 and a Celebration Dinner on  Thursday, Sept. 14. While these are free for competitors, a limited number of extra  tickets are available, at a cost of $15 for the Salmon Barbecue and $25 for the  Celebration Dinner.

 I would like an additional Salmon Barbecue ticket     Yes   No

 I would like an additional Celebration Dinner ticket   Yes   No