Pacific Puddle Jump 2012 Registration
ENTRY BASICS
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Establishing an account will allow you to make additions or changes later to crew, equipment or contact information. The account you establish is only for this form.
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to setup or return to your account for this form.
* indicates that a response is required
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Boat Name
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Boat Length (in feet)
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Boat Make/Model (i.e.: "Catalina 36")
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Boat's Homeport
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Boat Owner's First Name
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Last Name
Owner #2's First Name
Last Name
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Country of Boat's Registry
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Documentation # / Registration #
CONTACT INFO
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Primary Email Address
At Sea Email Address
Onboard Satellite Phone
Please note: The Rally Committee will send several informational emails to the fleet via both 'land-based' and 'at sea email' addresses. Messages sent to 'at sea emails' will always be as short as possible. We NEVER share fleet contact information with commercial commercial enterprises.
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Radios
VHF
SSB
HAM
SSB Call Sign?
HAM Call Sign?
BOAT INFO
Boat's Designer
Launch Date
Hull Color
Sail Number
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Length Overall
Beam
Displacement
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Rig Type
Masthead Sloop
Fractional Sloop
Ketch
Yawl
Schooner
Other
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Hull Material
Fiberglass
Wood
Composite
Steel
Aluminum
Ferrocement
SAFETY INFO
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Liferaft On Board?
Yes
No
Brand
Color (when deployed)
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EPIRB on board?
Yes
No
EPIRB Identifier Number
CREW INFO
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Captain's First Name
Nickname You Go By
*
Captain's Last Name
*
Country of Citizenship
*
Passport Number
*
Gender
Male
Female
*
Age
Occupation (former occupation if retired):
Retired?
Yes
No
Have you participated in a previous Puddle Jump . . .
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as Captain?
Yes
No
Which years?
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as Crew?
Yes
No
Which years?
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Emergency Contact
*
Email
___________________________________________________________________________________________
Crew #1 's First Name
Nickname You Go By
Crew #1's Last Name
Country of Citizenship
Passport Number
Gender
Male
Female
Age
Occupation (former occupation if retired):
Retired?
Yes
No
What is this crew's relationship to the Captain?
Spouse
Child
Friend
Other
Have you participated in a previous Puddle Jump . . .
as Captain?
Yes
No
Which years?
as Crew?
Yes
No
Which years?
Emergency Contact
Email
___________________________________________________________________________________________
Crew #2's First Name
Nickname You Go By
Crew #2's Last Name
Country of Citizenship
Passport Number
Gender
Male
Female
Age
Occupation (former occupation if retired):
Retired?
Yes
No
What is this crew's relationship to the Captain?
Spouse
Child
Friend
Other
Have you participated in a previous Puddle Jump . . .
as Captain?
Yes
No
Which years?
as Crew?
Yes
No
Which years?
Emergency Contact
Email
___________________________________________________________________________________________
Crew #3 's First Name
Nickname You Go By
Crew #3's Last Name
Country of Citizenship
Passport Number
Gender
Male
Female
Age
Occupation (former occupation if retired):
Retired?
Yes
No
What is this crew's relationship to the Captain?
Spouse
Child
Friend
Other
Have you participated in a previous Puddle Jump . . .
as Captain?
Yes
No
Which years?
as Crew?
Yes
No
Which years?
Emergency Contact
Email
___________________________________________________________________________________________
Crew # 4's First Name
Nickname You Go By
Crew #4's Last Name
Country of Citizenship
Passport Number
Gender
Male
Female
Age
Occupation (former occupation if retired):
Retired?
Yes
No
What is this crew's relationship to the Captain?
Spouse
Child
Friend
Other
Have you participated in a previous Puddle Jump . . .
as Captain?
Yes
No
Which years?
as Crew?
Yes
No
Which years?
Emergency Contact
Email
___________________________________________________________________________________________
PLEASE NOTE: If you have additional crew, email their info to andy@latitude38.com
OWNER'S BIO
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How long have you owned this boat?
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How many boats (not incuding dinghies) have you owned?
1
2
3
4+
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When did (each) owner start sailing?
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Give us a 'quotable quote' that describes your attitude toward this event.
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What's the most interesting thing about this boat (or your entry in the rally)?
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Point of departure for French Polynesia?
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Approximate date of departure for French Polynesia?
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Anticipated port of arrival in French Polynesia?
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Approximate date of arrival in French Polynesia?
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When and where did you hear about the rally?
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After the rally, what are your cruising plans?
LEGAL AGREEMENT
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I certify that all of the information above is correct to the best of my knowledge, and I agree that my participation in the the Pacific Puddle Jump Rally carries with it certain inherent risks ranging from minor injury to death. I acknowledge that my participation in the Rally is voluntary and that I am knowingly assuming all such risks. I further agree to indemnify and hold harmless Latitude 38 Publishing, the Tahiti Tourism Board and all other sponsors and supporters from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorneys’ fees, brought as a result of my involvement in the Rally.
Yes
No
___________________________________________________________________________________________
Mailing address:
Pacific Puddle Jump Rally c/o Latitude 38, 15 Locust Ave., Mill Valley, CA 94941 USA
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Indicates Response Required