Personal details

Name ...............................................................................................................

Street/PO ...............................................................................................................

Suburb  ......................................................Postcode  ..................

Telephone  ................................  Mobile  .............................................

email address  ................................................................................................

Date of birth  ........................  Dietary preferences  .......................................................

Medical conditions  ......................................................................................................... 

Allergies  ...........................................  Medications  .......................................................

Emergency contact details

Name ..................................................  Relationship.......................................................

Address  ..........................................................................................................................

Phone .............................. Mobile ............................... email ...........................................

Boating experience ...........................................................................................................

...........................................................................................................................................

Camping experience ..................................................................................................................

...........................................................................................................................................

Print this form and post to:

PO Box 79, Franklin, Tasmania 7113

or save as a pdf and send to coord@lbt.cccoco@bigpond.com.au

To make the payment of $50 for LBT members for the Members cruise over the weekend of April 24 - 26:

Make Internet Banking Payment to:

Bank…….CBA

Branch ….Huonville, TAS 7008

A/c name…The Living Boat Trust

BSB 06 7008

A/c no.  28031138

Please make sure you put your name as part of the “Reference” and it would assist the Treasurer if you could notify her by email that a remittance has been made (treasurer@lbt.org.au)

Or:

Cheque by mail to: The Treasurer, PO Box 79, Franklin, Tasmania, 7013 together with this form duly completed.