SKIPPER

(Name)

(Contact name)

(Phone H) Phone W)

(Email)

OWNER

(Name) (Address)

(Phone H)  (Phone W)

(Email)

VESSEL

(Name) (Doc. #) (Make) (Model)

(Description: color, type # of masts etc.)

PASSAGE

(From)   (Towards)

(Departing on or after) (Arriving not before)

CREW

(Number of crew excluding skipper)

1. Name)

 (Contact name)

 (Phone H)   (Phone W)   (Email)

2. (Name)

 (Contact name)

 (Phone H) (Phone W)  (Email)

3. (Name)

 (Contact name)

 (Phone H) (Phone W)  (Email)

4. (Name)

 (Contact name)

 (Phone H)   (Phone W) (Email)

EQUIPMENT

The vessel is equipped with the following items:

VHF radio  Lifejackets  EPIRB (121.5 MHz)  SSB / Ham radio  Harnesses  EPIRB (406 MHZ)  Fog horn  Emergency Liferaft  MOB pole  Flares,  Inflatable dinghy  Food and water