Photo: Picton Castle crew and locals on Pitcairn Island

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East Coast Challenge Summer 2007 Application

Please complete the following application for the East Coast Challenge—Summer Trip 2007.

Important!: This form is transmitted via email. Do not enter anything here that you wouldn't feel safe sending via email. Alternatively, you may download and complete the pdf version of this application and send it via mail or fax.

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:

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.)

Trip Leg Selection

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

Leg 1	Martinique to Charleston, SC	May 1 to May 18, 2007	18 Days
Leg 2	Charleston, SC to Norfolk, VA	May 18 to June 9, 2007	21 Days
Leg 3	Norfolk, VA to Newport, RI	June 10 to June 28, 2007	18 Days
Leg 4	Newport, RI to Halifax, NS	June 29 to July 14, 2007	16 Days
Leg 5	Halifax to Lunenburg via Sydney	July 15 to July 28, 2007	14 Days

Special Skills

Special skills or training:

Interest and Contribution

What interests you most about this voyage?

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

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.)?

Ever snorkel?
Yes No

Do you SCUBA dive?
Yes No

Additional Comments

Anything to add?

Please Provide Three (3) Character References

	Name	Relationship	Telephone Number
Reference 1
Reference 2
Reference 3

Barque Picton Castle

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East Coast Challenge Summer 2007 Application