Guest Crew Application Part 1 Step 1 of 3 33% Applicant InformationName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Phone*Email* Are you comfortable allowing Pride, Inc. to distribute your contact information to fellow guest crew members for the purpose of making travel arrangements, sharing photos, etc.?* Yes No Gender*Please selectFemaleMaleOtherDate of birth* MM DD YYYY Height*Weight*Guest Crew PassagesFirst choice passage:*2019 Buffalo to Cleveland - July 7-11 ($500)2019 Cleveland to Bay City - July 14-18 ($500)2019 Bay City to Green Bay - July 21-25 ($500) - Wait List2019 Green Bay to Kenosha - July 28-August 1 ($500) - Wait List2019 Kenosha to Midland - August 4-9 ($600)Second choice passage:*2019 Buffalo to Cleveland - July 7-11 ($500)2019 Cleveland to Bay City - July 14-18 ($500)2019 Bay City to Green Bay - July 21-25 ($500) - Wait List2019 Green Bay to Kenosha - July 28-August 1 ($500) - Wait List2019 Kenosha to Midland - August 4-9 ($600) Medical InformationThe captain must have knowledge of any medical conditions. Applicants over the age of 65 must provide documentation from their general physician or Internist, that in their opinion, there is no apparent reason to prevent the applicant from participating as an overnight guest crew member aboard a sailing vessel.Date of last physical exam* MM DD YYYY * An exam within one year of departure date is required.Do you have any limiting physical conditions, physical challenges, or disabilities that may impact your movement on board?*Please selectYesNoIf yes, please explain:Do you have any chronic illness (such as asthma, cardiovascular disease, diabetes, epilepsy, heart disease, hypertension, kidney or liver disease, osteoperosis, etc.)?*Please selectYesNoIf yes, please explain:Do you have any special dietary needs, or allergies?*Please selectYesNoIf yes, please explain:Do you have any mental or emotional challenges or conditions that may impact others in a group or impact your performance on board?:*Please selectYesNoIf yes, please explain:Please list all medical conditions (if none, please type "N/A"):*When was your latest (last) dental examination?* MM DD YYYY Do you have any pending dental concerns?*Please selectYesNoIf yes, please explain:Prescription Drug InformationPlease list all prescription drugs you intend to bring aboard PRIDE, the condition(s) they are treating, and any possible side effects if the medication is not available (if none, please type "N/A"):* Additional InformationHave you sailed on board PRIDE in the past?*Please selectYesNoIf so, please list years and ports:What prompted to you want to sail on board PRIDE?*How did you find out about the PRIDE overnight guest crew program?*Do you have any experience on the water (small boats, military, yachting, racing, training ships, etc.)?*Please selectYesNoIf so, please explain:What are you looking forward to most about your trip on board PRIDE?*AcknowledgementOvernight guest crewing is a participatory experience - standing watch for four hour durations, taking a turn at the helm, doing boat safety checks, helping with sail handling, helping with domestic chores, etc. Are you capable and willing to participate?*Please selectYesNoAcknowledgement* I hereby certify that the information provided in this application is true and accurate to the best of my knowledge.