Hereby I enroll for the:

Belterwiede “punter” Weekend 3/4/5 may

name ;………………………….

Town / Country : ………………………………

mobile phone : ………………………………

e-mail : ………………………………

I bring my own boat : her name…………………

type of boat : ………………………………

I come without a boat and use the traditional “sailing punters “   Yes  /  No

I will take with me : …… crewmembers.

Their names : ………………………………………………………………..

Ages (children) : …………………………

I will sleep in the Tipi tents with ….. persons

I prefer to sleep: my own boat, tent , different …………

I plan to arrive around………..Hour on Friday

I will pay for my participation  € 65 /person  On acc.nr.:48 60 21 122 from

S.O.Kingma Boltjes Tuk, the Netherlands

IBAN: NL04ABNA0486021122

BIC: ABNANL2A

Disclaimer: I agree that my participation is at my own risk

The weekend can be cancelled in case of bad weather. (non refundable)

Contactperson for emergency’s name……………… phone number……………

Signature:    ………………………………………………..

Please mail this form to boltjes@uittuk.nl also for questions.