APPLICATION FOR SEAGYPSY EXPEDITIONS
Open this email form, copy and paste this page into it, fill it out online, type your signature in and then
click Send. Or copy and paste it into a new document, then fill it out offline before emailing to
admin*AT*seagypsysailing.com. I will ask you to sign it properly again when you arrive.
This application is to make it easier for me to get to know you better before a telephone interview and
meeting in person. It will also help you decide if Eidos is the boat for you.
Name _______________________________________________________
Date of Birth ____________Age____________ Sex_________
Address:_______________________________________________________
City_______________________ State/Province _____ Zip _____________
Phone: Day (____)_________________ Evening (____)__________________
Cell (____)____________________ Fax (___)___________________
E-mail _______________________________
Height ______ Weight ______ Marital Status ______
Passport No. ________________________Nationality__________________
Occupation___________________ Position___________________________
Employer______________________________________________________
Please describe your work responsibilities: ___________________________
______________________________________________________________
Cruising Choice: Leg________ Date ___________
Second Choice: Leg________ Date ___________
Please tell me your reasons for wanting to sail on Eidos. Use an additional page if you'd like:
How did you learn of this voyage?
Have you ever participated in an expedition (climbing, hiking, rafting, sailing)
Have you been in a challenging situation at sea? Please describe it here
Sailing is a physically demanding endeavor. Please describe your regular physical activities or sports.
Include what types of exercise you pursue, how often, and the length of time. If you do not exercise
regularly, use this space to tell me of your personal fitness commitment if accepted to sail on Eidos.
Please list your sailing and navigation experience, including any night sailing, heavy weather experience
and if you've sailed out of sight of land.
Have you received any instruction on coastal or celestial navigation?
Do you presently own a boat?__________________ If so, what type?
Do you belong to a sailing club?______
Name and Location_____________________________________________
Have you ever chartered a sailboat? ______
Bareboat or with a skipper?________________________________________
Please include chartering details.
What skills do you have that could prove useful aboard? (Culinary, medical, mechanical, etc.)
What languages do you speak?
How would you rate your cooking skills? Good _____ Average _____ Poor _____ Non-existent ______
What is your favorite meal to prepare for others:
aboard a boat? _________________________________________________
at home?____________________________________________________
What are your food likes and dislikes?
Do you smoke? __________ Snore? __________ Have food allergies?
For your application to be considered, please attach a recent photo.
If your application is accepted, I will phone you once I reach port for a telephone interview and to
answer any questions. At that time we may arrange for a personal meeting.
MEDICAL APPLICATION
Name_______________________________________
Date of birth ______Age _______Sex______
Day phone(___)___________Evening phone (___)_____________
Fax No. (___)______________Email: ______________________________
Height ______Weigh _________Expedition Leg______ Date_______
In case In case of emergency notify:
______________________________Relationship______________________
Day phone (___)_________________Evening (___)____________________
Fax (___)__________________E-mail _______________________________
MEDICAL HISTORY:
Please explain all YES answers in detail, using an additional page if needed.
Do you have any existing medical conditions or problems? ______ If so, please
describe.
Have you been hospitalized in the past five years?
Do you take any medication regularly?_____ If so, what type and for what
condition
Have you experienced seasickness?_____ What are the roughest sea conditions you've encountered?
Have you used prescription seasickness medications?_____ If so what
type?
Have you ever suffered any gastrointestinal disturbances including colitis, ulcers or stomach problems?
If so, please describe.
Do you have any allergies, including allergic reaction to any drugs? Which ones and to what effect?
Do you have any food allergies or special dietary needs?
Have you ever received psychological counseling or medication for depression or any other
psychological challenges? ______ If so, please describe.
Have you ever been treated for alcohol or substance abuse? _______ Do you smoke? _________
Do you have, or have you ever been diagnosed as having: diabetes, epilepsy, high blood pressure,
high cholesterol, cardiovascular disease, migraines, asthma or lung disease, any significant back, knee,
foot or leg problems, or any other diseases or conditions?_______ If so, please explain.
Name of your physician______________________________________________________
Address__________________________________________________________
__________________________________________________________
Telephone(___)__________________E-mail________________________
SWIMMING ABILITY
Falling overboard while underway aboard Eidos is a very real possibility. Your ability to swim is crucial to
your survival during a man overboard rescue situation.
By signing this document, you hereby acknowledge that you can comfortably swim:
1. At least 50 yards in moderate open ocean water.
2. You can tread water for at least 15 minutes in moderate open ocean water.
I_____________________________ hereby acknowledge that I can swim at least 50 yards in moderate
open ocean water and tread water for at least 15 minutes in moderate open ocean water.
SIGNATURE DATE
INSURANCE
I understand the importance of Travel Accident and Sickness insurance if not covered by my existing
medical insurance.
______________________________________________________________
SIGNATURE DATE
PHOTO RELEASE
I,_________________________ hereby agree to give Barbara Molin the use of photos or video tape
footage of me in books, articles, catalogs, television programs or brochures without compensation.
I understand that if modeling fees are available, the manufacturer or distributor will pay them directly to
me.
______________________________________________________________
SIGNATURE DATE