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CREW PROFILE FORM
Thank you for joining our team! As you will soon be boarding the Sea Dragon we need some information from you for a smooth voyage.
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CONTACT DETAILS
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Address Line 1
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Address Line 2
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City
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State/County
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Trip
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Select your voyage
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May 2019: Border Run | San Diego to Ensenada
May 2019: Pineapple Express | Ensenada to Hawaii
June 2019: Pacific Explorer | Hawaii to Kiritimati
July 2019: Pacific Voyager | Kiritimati to Hawaii
July 2019: North Pacific Gyre | Hawaii to Victoria
August 2019: Gulf Islands | Victoria to Seattle
August 2019: San Juans | Seattle to Vancouver
Zip/Post Code
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Country
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Email
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Phone Number
No formatting please! For example: 19204121234
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How did you find out about Pangaea Exploration / this expedition?
Please be as specific as possible
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Passport Details
Full Name as written on passport (first, middle, given/last name/surname)
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Passport Number
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Nationality
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Date of Birth
Format: dd-Mmm-yyyy For Example: 22-Jan-1985
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Date of Issue
Format: dd-Mmm-yyyy For Example: 22-Jan-1985
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Date of Expiry
Format: dd-Mmm-yyyy For Example: 22-Jan-1985
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Sex
Female
Male
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Emergency Contact/Next of Kin
Name
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Emergency Contact Relationship
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Emergency Contact Home Phone Number
No formatting please! For example: 19204121234
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Emergency Contact Mobile Phone Number
No formatting please! For example: 19204121234
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Emergency Contact Email Address
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Arrival Date, Time, and Flight Number
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Departure Date, Time, and Flight Number
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Please check if you require visas for departure and/or arrival ports
No, I don't need one
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(if yes) Approved visa number
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Practical Information
Dietary requirements and food allergies
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Maritime training/experience (if any)
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Medical Conditions
Please remember offshore sailing can be a strenuous activity and you will be a long way (many days) from medical help. There is a separate comprehensive medical history form to fill out but please use this box to tell us if there is an ongoing health concern we should discuss beforehand. Thanks.
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Can you swim?
*
Yes
PUBLIC PROFILE
This information will be distributed to the team and posted on the Pangaea Exploration website
Background and area of expertise
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Goals and aims for the expedition
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SEND US A PICTURE OF YOU
As soon as you submit this form please send a head and shoulders photo of yourself to
info@panexplore.com
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