CYCA Youth Sailing Academy Application Form

Summer Performance Squad 2017

International Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code / Zip

Country

Date of Birth:

Phone Number

Email Address

Are you a CYCA member?

Yes

Have you participated in a YSA Course before:

Yes

If yes, what squad/course did you participate in and when?

Please provide a brief CV of your sailing experience:

Preferred Position:

Skipper

Main

Trim

Bow

Float

Payment Details

Season Pass:

Full Season - $500.00

Pay-per-Session - $50.00

Credit Card Details

Type of Card

Name on Card

Card Number

Expiry

CVV

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.