Guest Crew Application Part 2 Applicant InformationName* First Last Email* T-shirt sizePlease selectSmallMediumLargeX-LargeXX-LargeTravel InformationFor international travel (including Canada, Mexico, and the Caribbean), you must provide a copy of your passport and any VISA or other entry documents required by U.S. Customs or Homeland Security to the Pride, Inc. office prior to boarding. For U.S. passages, you must provide a copy of your driver’s license and/or birth certificate. You may email copies of documents to firstname.lastname@example.org or fax to 443.377.3897. Passport #Driver's license #*State issued*Date of birth* MM DD YYYY Birthplace*Emergency InformationName of emergency contact* First Last Relationship to passenger*Primary phone number*Alternative phone numberEmergency contact email Additional Medical InformationDoctor's name* First Last Doctor's phone number*Name of health insurance provider*Address of provider Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussiaRwandaRéunionSaint 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 IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Group number*Release of Liability and Acknowledgement of Passenger ResponsibilityIn consideration of being a passenger on the United States Coast Guard certified passenger carrying auxiliary sailing vessel Pride of Baltimore II, I do hereby make the following statement concerning liability and acknowledgement concerning my responsibility and safety as a passenger: I acknowledge, as a passenger, that I have no responsibility to perform as a crew member of the vessel; that my responsibility is to obey the orders and policies of the Captain, officers and crew of the vessel; and that I will remain in designated passenger areas when requested to do so. I also acknowledge that compliance with safety regulations and other precautions does not guarantee against maritime vessel sinking, deaths, and injuries at sea; and that such occurrences have taken place in the past and will continue to be risks. Insofar as my interest to sail aboard Pride is to be a participant, much like a crew member, I hereby willingly assume my own risk when participating in any activities that are not the normal activities of a passenger, but are really the responsibility of the crew. In addition, I assume any and all risk of injury to my property or my person, including loss of life, while a passenger aboard Pride of Baltimore II, and hereby, on behalf of myself and my personal representatives, hold harmless Pride of Baltimore, Inc., its directors, officers, employees, and agents from and against any liability for any such injury, damage, or death save and except any such loss or claim which results from the negligence or willful misconduct of Pride, its employees, agents, and representatives, or any negligent acts or omissions in connection with the proper maintenance of Pride of Baltimore II.I also give permission for photographs and video to be taken at the event in which my image may be used for promotional and/or advertising purposes by Pride of Baltimore, Inc. and/or its assignees in any medium, without compensation to me. Release* I hereby certify that I have read and understand the Release of Liability and Acknowledgment of Passenger Responsibility. I further certify that the information that I have provided in this application is true and accurate to the best of my knowledge, and I understand that Pride of Baltimore, Inc. has relied upon my representations when considering my guest crew application. I hereby agree to the Release of Liability and Acknowledgment of Passenger Responsibility.