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EMERGENCY CONTACT INFORMATION

The Australian Maritime Safety Authority (AMSA)have requested that we provide them with the following information in case of an emergency situation.

Please complete ALL fields on the form below and click submit when you are finished so that we may pass this information onto them.

If no Australian Registration number please type No Australian Rego Number
*If more than one PLB is on board the vessel please list all HEX ID numbers for all PLB`S *If you intend to purchase PLB`S before you depart please email downunderrally@gmail.com with the details of those items when purchased.
Name of vessel captain *
Name of vessel captain
Name of vessel captain next of kin *
Name of vessel captain next of kin
Name of crew member 1 *
Name of crew member 1
Name of crew member 1 next of Kin *
Name of crew member 1 next of Kin
Name of crew member 2
Name of crew member 2
If no 2nd crew member please leave blank
Name of crew member 2 next of kin
Name of crew member 2 next of kin
If no 2nd crew member please leave blank
If no 2nd crew member please leave blank
Name of crew member 3
Name of crew member 3
If no 3rd crew member please leave blank
Name of crew member 3 next of kin
Name of crew member 3 next of kin
If no 3rd crew member please leave blank
If no 3rd crew member please leave blank
Name of crew member 4
Name of crew member 4
If no 4th crew member please leave blank
Name of crew member 4 next of kin
Name of crew member 4 next of kin
If no 4th crew member please leave blank
If no 4th crew member please leave blank
Are there more than 4 crew members joining the vessel for the voyage to New Caledonia ? *
If more than 4 crew are joining the vessel for the voyage to New Caledonia please email downunderrally@gmail.com with crew member names and next of kin name and contact phone number as soon as possible.

IMPORTANT !!

Should any of the information you have provided change between now and when the rally departs please be sure to email the Down Under Rally and provide us with updated information