Sailing Trips Application Form

The Sail 4 Cancer Continues!

We are currently putting together our sailing programme for 2012, but rest assured there will be plenty of opportunities for cancer patients, their families and those recently bereaved through cancer, to get out on the water in 2012. To take a look at what's on offer so far, please click here>

If you would like to apply for a place for you and your family on one of our sailing trips or to nominate someone you feel really deserves a break, please fill in the form below. Please be assured we will deal with your application as quickly as possible, though there might be a slight delay in our response as we can become inundated with requests.

Once we have your application, we will contact you to find out more and request a medical reference from the person who has been nominated to check suitability for the chosen activity.

If you have any further questions please contact us.

NOTE: These sailing opportunities all start and finish within the UK.

Application Form

Your name:

Your email:

Your phone no:

Nominee name:

Nominee email:

Nominee phone no:

Nominee Address:

City:

Postcode/ZIP:

Country:

*

Your relationship to the nominee (e.g. friend):

Does the nominee know that you have put his/her name forward?

Yes  No

Are you comfortable that we now contact him/her directly?

Yes  No

Which sailing option are you interested in:

Please could you give the reasons why you feel this person would
benefit from a sailing experience/holiday with Sail 4 Cancer:

Please include as much detail as possible, including the dates of illness, the severity and the ongoing prognosis; the age of the nominee, current level of fitness (i.e. are they well enough to go sailing/on holiday) and how you feel a holiday/sailing experience will help them.

Where did you hear about Sail 4 Cancer?:

Please give details of any Sail 4 Cancer activities you have been on before:
 

SAILING TRIPS...

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