Sign up AC CONTEST 2024

ATLANTIC CHALLENGE CONTEST TRAINING EXPEDITION
July 7 - July 29, 2024
Training on Greens Island 7/7-20
Participation in Contest of Seamanship in Belfast, ME 7/21-28
*Program ends morning of 7/29

* Indicates required field

1. Name *

First

Last

2. Email *

3. Address *

Line 1

Line 2

City

State

Zip Code

Country

4. Phone Number *

5. Date of Birth (Month/Day/Year) *

6. Your Pronouns *

She/Her He/Him They/Them

7. Emergency Contact *

First

Last

9. Emergency Contact Email *

11. Health Insurance Provider *

8. Emergency Contact Relationship To You *

10. Emergency Contact Phone Number *

12. Health Insurance Policy Number *

13. Please list any medical conditions you have and any medications you are taking: *

14. Are there any physical or medical conditions that would affect your ability to participate fully in rowing and/or sailing? *

No Yes

Please describe: *

15. What is your height (feet and inches) and weight (pounds)? *

16. Please list any dietary restrictions/needs: *

18. List any other medical conditions or pertinent medical history not covered above *

19. Please describe how you treat or care for your physical or emotional health care needs: *

20. Please list all allergies and reactions you have to food, plants, medications, and/or insect bites and stings? *

21. Do you use an epinephrine injector? *

Yes No

22. Do you use an asthma inhaler? *

Yes No

23. What do you hope to gain from this experience? *

24. How did you find out about Atlantic Challenge? *

25. Do you have any questions or concerns about getting into the water (60 degrees F). We plan to dip most days. We will have lifejackets and can rig swim ladders from the dock and boats. *

26. Payment information. Please select your sliding scale tuition rate based on your total annual household income(s). *

Annual household income up to $29,000 – Tuition: $1500 $30,000-$49,000 – Tuition: $1875 $50,000-$99,000 – Tuition: $2500 $100,000-$184,000 – Tuition: $3125 $185,000 or more – Tuition: $3500 Will submit financial aid form

27. $100 deposit is due at this time in order to hold your place in the program. Please select your payment method: *

Pay online Pay by check. Make check to Atlantic Challenge USA, 20 Star Ave, Riverside, RI 02915 Waive $100 deposit fee

Thank you! We'll be in touch shortly to ask you any questions, and to let you know the status of your acceptance into this program. Instruction, insurance, and meals are included in tuition. Do you have any questions at this time? *

ATLANTIC CHALLENGE CONTEST TRAINING EXPEDITIONJuly 7 - July 29, 2024 ​*Training on Greens Island 7/7-20*Participation in Contest of Seamanship in Belfast, ME 7/21-28*Program ends morning of 7/29

ATLANTIC CHALLENGE CONTEST TRAINING EXPEDITION
July 7 - July 29, 2024
Training on Greens Island 7/7-20
Participation in Contest of Seamanship in Belfast, ME 7/21-28
*Program ends morning of 7/29