Please use the PRINT button below to print out a copy of this form. Fill out the form completely and mail it to:

NOTE: A signed and dated copy of this form must be received byU-Sail before your application will be accepted.

Personal information

First name:


Last name:


Email address:


Street Address:

City: State: Zip:

Primary phone number:
Alternate phone number:
Format: 123-456-7890

Driver's license:


Date of birth:

Format: mm/dd/yyyy

Emergency contact:

Phone:
Relationship:

Please list existing marine/sailing/boating organization or club membership(s):

Organization	Membership Number
Florida Boating Safety Identification Card
American Sailing Association
US Sailing
Boat US

Other organizations and their membership numbers (if any):


List any formal training you have had in boating, sailing, or flying, such as Coast Guard Auxiliary, ASA, US Sailing, Power Squadron, Red Cross, Private Instruction, Civil Air Patrol, Commercial Pilots License, Merchant Marine Captain, Mate, Deck Hand, etc.List types of previously sailed vessels/boats and years of experience on each type (continue on the back of the printed form if more space is needed):


List types of previously sailed vessels/boats and years of experience on each type:


List potential crew (including sailing experience) and relationship:

Signature: Date:

NOTE: A signed and dated copy of this form must be received byU-Sail before your application will be accepted.