Name and surname
email
Date of birth (DD-MM-YYYY)
Passport number
nationality
any dietary requirements / allergies
Are you taking any medication? If yes please list below:
Emergency contact – name and telephone number
applying for which trip – dates on board please
I confirm that I have read and understood terms and conditions (http://polishedmanx.net/terms/) I declare that I am fit to undertake the trip at sea on a sailing yacht? [recaptcha]
