KISS Registration Form

Queenscliff Cruising Yacht Club
KISS PROGRAM REGISTRANT DETAILS

Please complete this online form with the information requested, then click 'Submit' at the foot of the form. There is no need to print the form.
Name *

First Name Last Name
Email *
example@example.com
Mobile *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State

Post Code
Your usual club is *
Sailing experience *
Please enter a short summary of your sailing experience
Do you have a boat to sail on for the KISS Passage Race on Saturday 30th July? *

Yes No
We will work on finding a boat for you. Please now click 'Submit'.
Will you be skippering a boat? *

Yes No
Are you the boat owner? *

Yes No
Is the boat owner willing to provide their boat to participate in the KISS passage race on Saturday 30th July 2022? *

Yes No
Boat Details
The boat you sail on is named *
Sail no *
Boat design *
Length (m) *
Draft (m) *
Tonnage *
AIS transmitter *

Yes No
Boat insurance

QCYC requires a copy of the Certificate of Currency for boat insurance with public liability cover of >$10m which includes insurance for racing.
Insurance Company *
Policy number *
Expiry date *

Day Month Year
Date
>$10m public liability cover including racing? *

Yes No
You have indicated that your boat is not insured for racing. Please contact us at kiss@qcyc.org.au to explore other avenues for participating in the KISS Passage Race.
Boat Owner Details
Boat owner is named *

First Name Last Name
Boat owner's email address *
example@example.com
Boat owner's phone number *
Please enter a valid phone number.
Boat owner's address *

Street Address

Street Address Line 2

City State

Post Code
Boat owner's usual club is *
Should be Empty:

Queenscliff Cruising Yacht Club

KISS PROGRAM REGISTRANT DETAILS

Boat Details

Boat insurance

Boat Owner Details