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NameLast NameNED 12What type of A-Class?Entry Fee PayedBoat BrandMastSailmakerE-mailadres
What is the name of your sailing club?
AddressPostal codeCity:CountryEmailTelephone number
Telephone number in case of an emergency
Insurance Company
Insurance Policy Number
I will send a copy of my insurance to info@hellecat.nl
I want to reserve the following amount of extra guests for the social program:
Please specify if are there any allergies or food issues that need to be taken into account and for how many people.
T-Shirt Size ( one T-Shirt is included in the subscription fee)
Extra T-Shirts can be ordered for 20€, please specify number and size of extra t-Shirts:
I have read the NOR of the 4 Nations Cup 2020 and I agree with it:
If due to Covid-19 the event will not take place i want
Boats can arrive from the weekend before the event (29 - 30 August) and stay at the club without extra charges till the weekend after ( 12 - 13 September). Transport to the beach is also guaranteed Thursday 3 September from 17:00. On Friday 4 September the transport of the boats to the beach will be guaranteed from 8.00 to 10.30. Please specify your estimate day of arrival:
I will have a support boat:
I hereby declare that i filled in this entry form accurate and truthfully
2
ClaudeBrasseurBEL 10ClassicYesExploderSaarbergHammer Sailbrasseurclaude26@gmail.comSNEH
rue des Ecaussinnes, 53
7070Le RoeulxBelgique
brasseurclaude26@gmail.com
0032/4752755380032/479933125Insura Marine3.475.072YesLYesto be reimboursedThursday 3 SeptemberNoYes
3
BenoitVan PeeterssenBEL 13ClassicYesBimare ZeroSaarbergX voilesbvanpeeterssen@gmail.comSNEH3 rue Formahon7190EcaussinnesBelgique
Bvanpeeterssen@gmail.com
00324835065240032474555248AG Insurance03-65209408Yes0MYesto be reimboursedThursday 3 SeptemberNoYes
4
EricMeertBEL 63ClassicYesMarstroemFiberfoamhammereric.meert.63@gmail.comRBSC DUINBERGEN elizabethlaan 214/448301Knokke-heistBelgium
eric.meert.63@gmail.com
+32475488713+32477530154NN678658YesLYesto be reimboursedThursday 3 SeptemberNoYes
5
Philippe Muyzers BEL 54ClassicYesVisionSaarbergOXOconfiserie.philippe@gmail.comSNEH 113 av Gevaert 1332GenvalFrance
confiserie.philippe@gmail.com
+32486532188+32486532188Nationale nederlanden2430373YesXLYesto be reimboursedSunday 30 AugustNoYes
6
SergeDe BlockBEL 7ClassicyesVisionSaarbergHammerbrasseurclaude26@gmail.comSNEH37, rue du Sart Pultart6060GilyBELGIQUE
sergedeblock@hotmail.com
0032/ 474 76 71 560032 /498 68 31 43Insura Marine3.475.277Fournie sur placeNO0XXLYesto be reimboursedThursday 3 SeptemberNoYes
7
WalterGonzalezBEL 87ClassicYesDNAFiberfoamHammertriline@scarlet.beSNEH7A Rue des Praules5030GemblouxBelgiumtriline@scarlet.be00324755023030032476634356AXA515881138YesXXLYes
to use the registration fee for other events taking place at Hellecat
Thursday 3 SeptemberNoYes
8
FrankDeneveBEL 88ClassicYesMarström M4FiberfoamLandenbergerfrank@e-on.be
RBSC Duinbergen Belgium
Knokkestraat 268/118301Knokke-HeistBelgiumfrank@e-on.be+32473887878+32473887878Pantaenius11565375-11
I have it with me at arrival
XXLYesto be reimboursedThursday 3 SeptemberNoYes
9
MichelWarlopBEL 9ClassicYesMarstromHammer Sailsmichel.warlop@outlook.comAnemosMaleizenstraat 263020HerentBelgië
michel.warlop@outlook.com
+32475802895+32475802895Nationale Nederlanden511683Yes0NoLYesto be reimboursedFriday 4 SeptemberNoYes
10
MickyToddESP 7ClassicYesSchurer G6FiberfoamHammermickypinkhammer@hotmail.comCAR25 Elmwood G11 7EDGLASGOWUnited Kingdom
mickypinkhammer@hotmail.com
07501081482+441415635212W.H. Insurance128869YesXXLYesto be reimboursedSunday 30 AugustNoYes
11
Owen CoxGBR 72ClassicYesDNAFiberfoamBrewincoxengineering@hotmail.comBala sailing club
Heatherfield, Plas Bennion Road, Pen Y Cae, wrexham.
LL14 1TPWrexhamUnited kingdom
coxengineering@hotmail.com
0748334996001788579913Craftinsure12345678Yes1NoneXLYesto be reimboursedThursday 3 SeptemberNoYes
12
ChristianStockGER 100ClassicyesNikitaSaarbergLandenbergerfree5251@yahoo.com
Segelverein Schluchsee
Holbeinstr. 2679100FreiburgGemanyfree5251@yahoo.com++49 1525 5295837++49 761 6800087HelvetiatbaYes0LYesto be reimboursedThursday 3 SeptemberNoYes
13
JanKreutzmannGER 34ClassicYesExploderFiberfoamNorth Sailsjan-kreutzmann@arcor.de
Yacht-Club Niedersachsen ( YCN )
Weidenbruchsweg 831535Neustadt Germany
jan-kreutzmann@arcor.de
+49 1725130144+49 5036 2922
Nürnberger Insurance Group
16.330.625YesLYesto be reimboursedThursday 3 SeptemberNoYes
14
UlrichZühlkeGER 44ClassicYesVisionSaarbergLandenbergeru.zuehlke@t-online.de
Segler Club Clarholz (SCC)
Fernholzstr. 3348159MünsterDeutschlandu.zuehlke@t-online.de0157342886760049251211833Pantaenius11517822-11Yesno extra guestsno allergiesSYesto be reimboursedThursday 3 SeptemberNoYes
15
ThomasBeckerGER 577ClassicYesFlyerSSaarbergAshbyRassmus-1@gmx.deMSVAlter Holzhafen 2723966WismarGermanyRasmus-1@gmx.de038412502230176 50903654
Zz nicht bekannt ( Urlaub)
S.o.Yes1LYesto be reimboursedThursday 3 SeptemberNoYes
16
GeorgMerklGER 537ClassicYesFlyerSaarbergLandenbergermerkl.georg@t-online.deWSGRWaldstr. 2a91054ErlangenDeutschland
merkl.georg@t-online.de
+491715481498+4916096824599
Mannheimer Versicherung AG
TK373-4758599-424471
Yes4n. a.Ln. a. Yesto be reimboursedSunday 30 AugustNoYes4
17
PieterSaarbergNED 1ClassicYesVisionSaarbergLandenbergerpsaarberg@catamaranparts.nlHellecatCelsiusstraat 2102041TRZandvoortNederland
psaarberg@catamaranparts.nl
06534080750235718695NN5110016488Hebben ze al.LYesto be reimboursedSaturday 29 AugustNoYes
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Jaap Straakenbroek NED 108ClassicYesDNAFiberfoamMischa Sailsjastra21@zeelandnet.nlCatclub ZeelandMuddy Watersstraat 644337WKMiddelburg Nederland
jastra21@zeelandnet.nl
06536280130646075294Kuiper verzekeringenP322-5282181022Yes1N0MYesto be reimboursedSunday 30 AugustNoYes1
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KeesKrijgerNED 15ClassicYesBimare V1RSaarbergLandenbergerkrijgercj@gmail.comCatclub ZeelandA. Pouwerstraat 104333MCMiddelburgThe Netherlandskrijgercj@gmail.com+31 6 228 43 118+31 6 81 59 43 83Ansvar Verzekeringen
Boot runnr 310520 Ansvar
YesXLYesto be reimboursedSunday 30 AugustNoYes
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Caroline Van BeelenNED 41ClassicYesNikitaSaarbergMischa Sailscvanbeelen@xs4all.nlCatclub Zeeland
Kennemerboulevard 666
1976erIjmuidenNlCvanbeelen@xs4all.nl06517892250651500386KuiperNed412020YesSYesto be reimboursedFriday 4 SeptemberNoYes
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FrankMauritzNED 85ClassicyesDNASaarbergLandenberger
frankmauritz.groningen@gmail.com
OmahoMooiland 679734 bwgroningenNederland
frankmauritz.groningen@gmail.com
0654235877
0614821922 (sandra de jong)
Eerdmans020-201902343YesSYesto be reimboursedThursday 3 SeptemberNoYes
22
Josje VerbeetenNED 100Classicyes
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PatrickDemesmaekerBEL 2FoilingYesExploderFiberfoamGoodallolivier@gomap.beRbscYsayelaan 88300Knokke heistBelgiumZeebrugge@rbsc.be+32495219922+32 475 58 18 85Huysmans12345678Ter plaatseNoXLNoYesto be reimboursedThursday 3 SeptemberYesYes
24
GaglianiOlivier BEL 32FoilingyesExploderFiberfoamMischa Sailsolivier@gomap.beRbsc belgium
Avenue Victor emmanuel III,65
1180UccleBelgiumOlivier@ gomap.be+3247542319000 32 497 75 91 49Huysmans 1234YesMYesto be reimboursedSaturday 29 AugustNoYes
25
VladislavPtasnikCZE 1FoilingYesExploderFiberfoamNorth Sailsvlada@compotech.comYK JestrabiHory matky bozi 6934142VelharticeCzech Republic
vlada@compotech.com
0042060623681800420721373082Allianz150003825YesXSYesto be reimboursedSunday 30 AugustNoYes
26
Emmanuel DODEFRA nFoilingYesExploderFiberfoamNorth Sailsdodeemmanuel@yahoo.frS R Vannes
27 Allée Du Bois Du Vincin
56000VANNESFRANCE
dodeemmanuel@yahoo.fr
+33 6 63 26 98 44+33 6 99 82 64 19FFV1030745TYesNoNoMNoYesto be reimboursedThursday 3 SeptemberNoYes
27
KatrinBrunnerGER 15FoilingYesDNAFiberfoamMischa Sailskatrin1brunner@gmx.deLindauer Seglerclub
Auf dem Hasenbank 31c
88131LindauGermany
Katrin1brunner@gmx.de
00491703227908004915202862967Uniqua2267/004541-2YesXSYesto be reimboursedSunday 30 AugustNoYes
28
HannesHaufeGER 150FoilingyesExploderFiberfoamLandenbergerhannes.haufe@gmx.deVDACBeim Schilingstift 4622589HamburgGermanyhannes.haufe@gmx.de+4917477990464917648500214Zürcher probably
123 I have to look up at home
YesXLYesto be reimboursedThursday 3 SeptemberNoYes1
29
ChristianSchäferGER 23FoilingyesExploderFiberfoamPink Hammerbutenbremer71@gmail.com
Segelklub Bayer Uerdingen
Am Striebruch 5240668MeerbuschGermany
butenbremer71@gmail.com
+491709457040+491709457040
Basler Sachversicherungs AG
322359-10140181YesMYes
to use the registration fee for other events taking place at Hellecat
Thursday 3 SeptemberNoYes
30
MatthiasDietzGER 3FoilingYesExploderFiberfoamLandenbergermatthias.dietz.bibi@t-online.deSLRVKirchgärten 1874321Bietigheim-BissingenGermany
matthias.dietz.bibi@t-online.de
07142 3166107142 31661
Nürnberger Insurance Group
16.331.023YesLYesto be reimboursedThursday 3 SeptemberNoYes
31
ThorstenLorenzGER 38FoilingYesDNAFiberfoamHammerthorsten.lorenz@web.de
Baltische Seglervereinigung
Gubiner Str. 10E30880LaatzenGermany
thorsten.lorenz@web.de
+4915111781365+495102931547
Gallion Versicherungskontor
W431372YesLYesto be reimboursedThursday 3 SeptemberNoYes1
32
ManfredSyrowyGER 40FoilingYesExploderFiberfoamMicky Toddsyrowy@syrostahl.de
Yacht-Club Niedersachsen
Am Gogericht 2630171HannoverDeutschlandsyrowy@syrostahl.de0178480872701784808726Alliance GlobalW384144YesLYesto be reimboursedThursday 3 SeptemberNoYes
33
JensKraussGER 43FoilingYesDNAFiberfoamHammer Sailsjenskrauss@arcor.deSegelverein BiblisPostfach 132764807DieburgGermanyjenskrauss@arcor.de+49 1718040887+49 1718040887Helvetia130.010.0307570.6Yes1NoXXLXLYesto be reimboursedSaturday 29 AugustNoYes1
34
RainerBohrerGER 6FoilingYesDNAFiberfoamMischa Sailsrainer.bohrer@gmail.comTSV UttingHofstattstr. 2086919UttingGermany
Rainer.Bohrer@gmail.com
+491732134025+491791035810
Hamburger Yachtversicherung Schomacker
610016019Yes2
2 People eating only vegan, vegetarian, fish or chicken (on red meat)
MYesto be reimboursedSaturday 29 AugustNoYes
35
MarenOdefeyGER 68FoilingYesExploderFiberfoamLandenbergerm.odefey@gmx.deMSV WismarLechweg 322393HamburgGermanym.odefey@gmx.de+4917657545430+4917649931684Eerdmans020-201902385YesSYesto be reimboursedThursday 3 SeptemberNoYes
36
Jörn Knop GER 75FoilingYesExploderFiberfoamHammerJoernknop66@Googlemail.comBSV Speckenstraße 1631515WunstorfDeutschland
Joernknop66@Googlemail.com
+491729508611+49503172431Bayrische1234Yes0NoLYesto be reimboursedThursday 3 SeptemberNoYes
37
GuidoSchulteGER 85FoilingYesExploderFiberfoamHammerguido.schulte@gmx.deMSV WismarLübsche Burg 1223966WismarGermanyguido.schulte@gmx.de+491703124821+491799792890Yacht-Pool1500-69773YesMYesto be reimboursedThursday 3 SeptemberNoYes
38
MischaHeemskerkNED 007FoilingYesDNAFiberfoamMischa Sailsmischa.heemskerk@gmail.comWSV de BraassemPampuslaan 661087LAAmsterdam Netherlands
mischa.heemskerk@gmail.com
+31647118478+31682657461Achmea765007689YesXLYesto be reimboursedThursday 3 SeptemberNoYes
39
Davidvan AartNED 111FoilingyesExploderFiberfoamBrewindvanaart@gmail.comHellecatVogelaardreef 122204AANoordwijkNEDdvanaart@gmail.com06214497230621449723Yachting24.com141548571YesnonoLnoYesto be reimboursedFriday 4 SeptemberNoYes
40
Eric LampierNED 12FoilingyesDNAFiberfoamMischa Sailse.lampier@telfort.nlHellecatParkweg 3- V0013221LVHellevoetsluisNLe.lampier@telfort.nl06533618290625164276Yachting 24 GmBH141542485-2 Yes0NoneXL0Yesto be reimboursedFriday 4 SeptemberNoYes
41
RutgerKrijgerNED 14FoilingYesExploderFiberfoamNorth Sailsrutgerkrijger@hotmail.comWsvwKennerboulevard 6661976erIjmuidenNl
rutgerkrijger@hotmail.com
06515003860650225583KuiperP322-5282190282YesLYesto be reimboursedFriday 4 SeptemberNoYes
42
JohnDe VriesNED 18FoilingYesDNAFiberfoamMischa Sailsdevriesstipt@gmail.com
Roerkoning muiderzand
Noordereinde 1031243JKS gravelandNED
devriesstipt@gmail.com
06532565460653256546Avero achmea5607-8123116YesNvtNonXSNoYes
to use the registration fee for other events taking place at Hellecat
Saturday 29 AugustNoYes
43
PieterjanDwarshuisNED 28FoilingYesDNAFiberfoamMischa Sailspieterjan@hollandcomposites.nlWv flevoRoermeen 33844 kaHarderwijkNetherlands
Pieterjan@hollandcomposites.nl
06532941070341456888Nationale nederlanden 2406486Yes0NoneLYes
to use the registration fee for other events taking place at Hellecat
Thursday 3 SeptemberNoYes
44
SjoerdHoekstraNED 3FoilingyesDNASaarbergMischa Sailsmail@sjoerdhoekstra.nlOmahoDuinkampen 259765 BAPaterswoldeNEDmail@sjoerdhoekstra.nl06127556190612201149SNS15118100003Yes0LYesto be reimboursedFriday 4 SeptemberNoYes
45
ThijsVisserNED 33FoilingYesDNAFiberfoamMischa Sailsthijs@vissersailing.comWerpanker 381319DD AlmereNetherlandsThijs@vissersailing.com0643852257+31 6 44 03 15 98Avero5607-8135876
They already have a copy
0LNoYes
to use the registration fee for other events taking place at Hellecat
Thursday 3 SeptemberNoYes
46
WiroZijlmansNED 44FoilingYesDNAFiberfoamMischa Sailswirozijlmans@gmail.comHellecatBisonlaan 95691GCSonNetherlands
Wirozijlmans@gmail.com
06512320700599464583NN650902YesMYes
to use the registration fee for other events taking place at Hellecat
Thursday 3 SeptemberNoYes
47
BertusVan DrongelenNED 5FoilingyesDNAFiberfoamMischa Sailsbvandrongelen@telfort.nlHellecatkarperveen 4683205HJSPIJKENISSENederland
bvandrongelen@telfort.nl
+31181648222+31181648222centraal beheer11570938
neem hem mee ter inzage
LYesto be reimboursedSunday 30 AugustNoYes
48
WimPlokkerNED 93FoilingYesDNAFiberfoamMischa Sailsw.plokker@upcmail.nlHellecatEsplanade 233221LWHellevoetsluisNetherlandsw.plokker@upcmail.nl+31634489858+31612797117NN625565Yes1noL0Yesto be reimboursedSaturday 29 AugustNoYes
49
RoelandWentholtNED 95FoilingYesDNAMischa Sailsroelandwentholt@gmail.comHellecatDa Costalaan 692281 seRijswijkNetherlands
Roelandwentholt@gmail.com
06531338270653133827FCODASSKD0003659YesLYesto be reimboursedSaturday 29 AugustNoYes
50
Gert-JanKosNED 96FoilingYesExploderFiberfoamLandenbergergjkos@hotmail.nlHellecat
Louise de Colignystraat 50-hs
1055XNAmsterdamThe Netherlandsgjkos@hotmail.nl06537140090653104583Dna639645YesMYesto be reimboursedFriday 4 SeptemberNoYes
51
MaierHeikoSUI 33FoilingYesExploderFiberfoamLandenbergerheiko_maier@yahoo.comRCZPilatusstrasse 16330ChamSwitzerland
heiko_maier@yahoo.com
+41 79 644 30 40+41 79 644 30 40Allianz SuisseT57.1.341.075Yes0--L0Yesto be reimboursedSunday 30 AugustNoYes
52
KlausRaabGER 5FoilingyesExploderFiberfoamNorth SailsK.H.Raab@t-online.de
Segelclub Füssen Forggensee
Wegscheiderweg 6b87629FüssenDeutschlandK.H.Raab@t-online.de+491717439144+49836239109UNIQA2267/004351YesNONOXLYesto be reimboursedThursday 3 SeptemberNoYes
53
RobbertKantNED 50FoilingyesDNANorth Sailskantrobbert@gmail.comHellecatSacharovlaan 683223 HNHellevoetsluis Nederland
Kantrobbert@gmail.com
06510663990613917233DNA596530Yes0M0Yesto be reimboursedFriday 4 SeptemberNoYes
54
Andrzej SenkusPOL 101FoilingyesExploderFiberfoamNorth Sailsasenkus@wp.plUKS Navigo Barokowa 1480-253Gdańsk Poland Asenkus@wp.pl+ 48 797596066
+ 48 515 591 673 , + 48 501 011 202
Ergo hestia 436000206134Yes0NoneLYesto be reimboursedThursday 3 SeptemberNoYes
55
Jarosław Bętkowski POL 3FoilingyesExploderSaarbergNorth Sailsbetkowski@europainwestycje.plRJKP PoznańŁŁakowiczówny 14/160-780PoznańPoland
betkowski@europainwestycje.pl
+48 604 484 446+48 604 484 446Ergo Hestia436000206134Yes0NoneLYesto be reimboursedThursday 3 SeptemberNoYes
56
Alex MeisterGER 27FoilingYesalexmeister@t-online.deYCNAstastraße 5033617Bielefeld Germany
alexmeister@t-online.de
00491788324163004915163339090
Will send by email and show at Check in at Hellecat
Will send by email and show at Check in at Hellecat
YesLYesto be reimboursedThursday 3 SeptemberNoYes
57
CapucineBertorelliFRA 411ClassicYesBimare Ashbycapucine.bertorelli@gmail.comACAL9, rue du Rhin67150GerstheimFrance
capucine.bertorelli@gmail.com
06297488970629414090FFV1374438GnonnonoXSnoYesto be reimboursedThursday 3 SeptemberYesYes
58
BenjaminWesterfeldFRA 554ClassicYessheurerhamerbencopelo@hotmail.comACAL 9 rue du Rhin67150GerstheimFrance
bencopelo@hotmail.com
06294140900629748897FFVOILE0563508Nnon*nonnonLYesto be reimboursedThursday 3 SeptemberYesYes
59
SamChauvinFRA 557ClassicYesFiberfoamLandenbergerchauvin.samuel92@gmail.comAcal4, rue de la Cité 56160LIGNOLFrance
Chauvin.samuel92@gmail.com
+336 63 35 04 01+336 29 70 34 19MacifN0001I will show it on siteLYesto be reimboursedThursday 3 SeptemberYesYes
60
Yves TheuninckSUI 88FoilingDNAFiberfoamMischa Sailsyves.theuninck@bluewin.ch
Club Nautique Pully (CNPully)
Route du Port 231009PullySwitzerland
yves.theuninck@bluewin.ch
+41 78 670 10 90+41 78 670 10 80AllianzT57.1.094.105YesXLYesto be reimboursedThursday 3 SeptemberNoYes
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