Sea Survival Please enable JavaScript in your browser to complete this form.Course Name *Date course starts *Name *FirstLastDate of Birth *We're not interested in your age, this is just a unique identifier for our records!Australian Sailing Number:Only if you have it! If you do not have a number, we will enter your details on the Australian Sailing system and give you your new number during your course.Email *EmailConfirm EmailAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodePhone *Next of Kin DetailsNext of Kin NameWho should we contact in case of emergencies?Phone numberAddressAddress Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryHealth DeclarationAlthough illness or medical conditions should not prevent you from taking part in this course, we must be aware of any issues that we may need to help you overcome. If you are in any doubt about your fitness to take part in this course, your GP should be able to advise you further.Please give details of any medical condition or current treatments *Please type "Nothing" if you have nothing to tell us!If you suffer from epilepsy, giddy spells, asthma, diabetes, heart condition or anything else you think may affect you during your course, please provide details below:Medical Declaration *I am (to the best of my knowledge) fit to take part in this course!About YouSailing/Sea ExperienceLet us know a little about your background so that we can tailor the course to your experience!Please tell us about your swimming ability below: *I can swim at least 25m in a swimming pool.I can swim between 15 and 25m in a swimming pool.I cannot swim 15m in a swimming pool (you'll still be able to do the course).Additional OptionsThe Safety and Sea Survival HandbookI'd like to buy the RYA SEA SURVIVAL HANDBOOKI'd like to buy the RYA SEA SURVIVAL HANDBOOK e- book These are $30 each which I'll take payment for at the course but you don't need to buy them. Some people like the book for reference, and the e-books work well on tablets.Equipment from use for the course:I'd like to borrow a lifejacket for the pool session.I'd like to borrow a lifeline for the pool sessionI'd like to use the automatic function on the lifejacket and understand there may be a $20 charge for this.We recommend you enter the pool in the normal gear you would wear on a cold and stormy night in Victoria. We prefer you to use your own gear so that you are familiar with it but we can supply gear if you need.Special Offer on Recommended LifejacketsYou can buy the items below for this price if you pick them up at the course, otherwise there is a $25 additional postage charge:Crewfit 180 Pro for inshore sailing $180 (RRP $219)ErgoFit 190N Offshore Lifejacket (Light and Sprayhood) $400 (RRP $469)Special prices only available to participants of Tasman Adventures Safety and Sea Survival Courses.MessageSubmit Details