EMERGENCY CONTACT INFORMATION

  • The details on this form will be received by Down Under Rally, Northland Radio, Noumea Yacht Services and AMSA.

  • Each vessel that is participating in the 2019 Go East Rally must complete ALL fields on the form below and submit the completed form no later than April 19th 2019

  • If you are unable to provide all the information required at the time of completing the form please do not proceed until you are able to do so, however, we must have received the completed form by the 19th April 2019.

    Please note: Details of next of kin are to be people who are NOT sailing on the vessel.


Vessel Australian Registration number.
Name of vessel captain *
Name of vessel captain
Name of Captain next of kin *
Name of 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
If more than 4 crew are joining the vessel for the voyage to New Caledonia please list additional crew member names, next of kin name and contact phone number of next of kin below.
If no satellite ph number type: No Sat Phone
If no SSB radio on board type NO SSB
*Please provide the HEX ID # for the primary EPIRB that is registered to your vessel with AMSA. *If your EPIRB is not registered with AMSA go to the following page of the AMSA website and complete registration now: www.beacons.amsa.gov.au
For example this could be the EPIRB in your liferaft
*If no PLB are carried please type NO PLB *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. *If your PLB is not registered with AMSA go to the following page of the AMSA website and complete registration now: www.beacons.amsa.gov.au
*If no PAB are carried please type NO PAB *If more than one PAB is on board the vessel please list all MMSI numbers for all PAB. *If you intend to purchase PAB before you depart please email downunderrally@gmail.com with the details of those items when purchased.

IMPORTANT !!

Should any of the information you have provided change after you have completed and submitted this form be sure to email the Down Under Rally and provide us with updated information