Photo: Picton Castle at Cape Town, South Africa

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World Voyage 5 Application

Personal Information

First Name:

Last Name:

E-Mail:

Street Address:

City:

State/Province:

Country:

Postal Code/Zip:

Phone (Home):

Phone (Work):

Fax:

Height:

Weight:

Sex: Female Male

Date of Birth:

Country of Citizenship:

Passport Number:

Have you ever been convicted of a criminal offence? Yes No

Referral Info

Where did you learn about this Voyage? (Please be as specific as possible. Some examples might be "Google Search", "ASTA Website", "Email From a Friend" and etc.)

Interest and Contribution

What interests you most about this voyage?

What do you think will be your personal contribution to the voyage?

Education and Work/Life Experience

Formal education:

Informal education:

Hobbies and interests:

Languages Spoken and/or Written:

What is your greatest strength?

Greatest weakness?

Special skills or training:

Travel experience:

Sort of jobs or employment you have had:

Describe your most important experience:

Health and Fitness

Are you claustrophobic? Yes No

How are you with heights? Okay Not Okay

How are your health and your physical condition?

Special medical conditions:

Any allergies (medicines, foods, insect bites, etc.)? Yes No
If Yes, please explain.

Any major hospitalizations? Yes No
If Yes, please explain.

Water and Boating Experience

Do you have any experience on the water (small boats, military, yachting, racing, training ships, etc.)?

Additional Comments

Anything to add?

Voyage Leg Selection

Please select legs you are applying for (legs and durations subject to change):

	Whole World Voyage 5	May 2010 to June 2011
	Leg 1	May 2010 to August 2010
	Leg 2	August 2010 to November 2010
	Leg 3	November 2010 to March 2011
	Leg 4	March 2011 to June 2011

Please Provide Three (3) Character References

	Name	Relationship	Telephone Number
Reference 1
Reference 2
Reference 3

Barque Picton Castle

Apply

World Voyage 5 Application