Mad'Air BASE Event - Application
Madeira - 16 - 20 may 2019
Email address *
Jumper
Family name *
Your answer
First name *
Your answer
BASE number (optional)
Your answer
Country *
Your answer
Phone number *
Your answer
E-mail *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Experience
Total number of BASE jumps *
Your answer
Number of wingsuit BASE jumps
Your answer
I want to jump: *
Required
Other activities I like to do on the island: *
Required
Other x-treme sports experience *
Required
BASE gear I use
Harness
Your answer
Canopy
Your answer
Motivation
I want to join the event because...
Your answer
We can accommodate non flying friends for you. The bed in same apartment is € 150,-. Tandem paragliding flights can be arranged on the island for € 50,- per flight.
Non flying friends you like to add? *
Legal disclaimer
Signing up for this event means means that you acknowledge the following:

Base jumping is a highly dangerous activity. It can result in serious injury or death. We do not encourage you to take up this activity. The initiaters of this event accept no responsibility, financially or otherwise for any loss, serious injury or death that occurs as a result of any person deciding to make a base jump during the Mad'Air event.

During the opening breefing, you have to read a disclaimer in front of a video camera and witnesses to join the event.

All activities described on the Mad'Air website, regardless of them being regular base jumps, wingsuit flights or Paragliding jumps, are extremely dangerous. Performing, or trying to imitate or mimic the activities described on the Mad'Air website without the proper training, or without becoming an expert skydiver and completing dedicated training (like First Jump Courses) will likely result in injury or death. Even with the correct training, these activities are extremely dangerous.

You and nobody else are responsible for your own safety and actions.

Are you sure? *
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service