Crewmember’s Questionnaire for SY Gedania voyage (only for participants with confirmation) You must have JavaScript enabled to use this form. 1 of 5 (0%) Indicates required field CONFIRM YOUR BOOKING WITH THE ORGANIZER BEFORE SENDING THIS FORM! Submitting this form without the previous confirmation is NOT EQUIVALENT with booking the spot on the voyage. × Close Warning message ×To begin download the attachment, fill in, sign, scan and have it ready in form of JPG or PDF file. You will be asked to attach the file on page 4 of this form. DOWNLOAD IMPORTANT: You must be at least 14 years old to send the form. Underage persons (<18) are required to have a written permission from parents or legal guardians. All the data you will provide on this page is send to a secure folder on an encrypted server without a third party access. Application for a voyage - Select -01/202102/202103/202104/202105/202106 /202106a/202107/202108/202109/202110/202111/202112/202113/202114/202115/202116/202117/202118/202119/2021 Rejs Nr: / Termin: - Trasa: Crewmember’s Info Last Name and First Name of the participant? Date of birth? Place of birth Age wiek lat Contact Information Contact E-mail Telephone Address City/Town ZIP/Postal Code Country - Select -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Document ID Passport ID Number Passport Number Safety/Emergency contact Emergency contact Last Name and First Name E-mail Telephone Are you of age (>18 years old)? An adult Yes No PARENTS / LEGAL GUARDIANS STATEMENT? * required for underaged participant Niniejszym wyrażam zgodę na udział w rejsie na żaglowcu s/y „Gedania” mojej córki /mojego syna: Last Name and First Name PARENTS / LEGAL GUARDIANS CONTACT INFORMATION Last Name and First Name E-mail Means of contact during the voyage: Address where the guardians might be reached during the voyage Telephone under which the guardians might be reached during the voyage Additional information regarding the participant (health, prescription drugs etc.) This is the information only for the Office and the ship’s master – treated as confidential data! YES – I consent to my daughter/son participation in the voyage on SY Gedania In case of any doubts or questions, please contact the STAP Office from Mon to Fri from 1000 to 1600 via e-mail: rejsy@pogoria.pl or by telephone: +48-58-620-62-26. Sailing certificates - Select -I don't haveżeglarz jachtowysternik jachtowyjachtowy sternik morskikapitan jachtowyjachtowy kapitan ż. w. How many times have you been on board of SY Gedania ??
