MUMBLES SAILING SCHOOL BOOKING FORM

                            Please print this page, fill in your details in the spaces in ink, then post the form to

                                                                          Vance Broad

                                                             Mumbles Sailing School Office

                                                                      17 Nobel Avenue

                                                                   Port Talbot SA12 6YN

                    with a cheque made out to Vance Broad enclosed with the Booking Form.

                Remember to keep your own note of the times and dates of the lessons you book.

Your name     ..........................................Telephone..............................Mobile....................................

Address ...............................................................................................................................................

Your shore contact ...................................Telephone..............................Mobile....................................

Your email address..............................................Your jacket size (please circle) XXL, XL, L, M, S, XS

Any medical, physical, psychological or nervous condition e.g. epilepsy, diabetes, motion sickness,

pregnancy, heart defect, phobia, allergy etc.  Condition .....................................If nil tick here ........

Sailing is a hazardous pursuit with similar risks to those involved in rock-climbing or ski-ing. Are you fit

enough to take full responsibility for your own safety under professional supervision? Yes or No ............

I have/do not have Personal Accident Cover Insurance (delete one option please)

Scheduled date of first lesson .......................................................... (enter course name, date and time)

Please give a brief description of your sailing experience ........................................................................

Nil is acceptable (even preferable) as you will not have acquired any bad habits or perfected imperfections.

Please sign here .............................................................................Date.................................................