The 2007 Atlantic Voyage of The Schooner La Revenante:

NAME:   _______________________________________________
ADDRESS: _____________________________________________
EMAIL :  ________________________ PHONE:________________

LEG REQUESTED: ( mark all that apply: (1) First choice (2) Second choice) 

BROCKVILLE - QUEBEC CITY             _____________
QUEBEC CITY – CHARLOTTETOWN  _____________
CHARLOTTETOWN – HALIFAX           _____________
COASTAL VISITS                                     _____________
RETURN TRIP                                          _____________

EXPERIENCE: ______________________________________________________________________________

____________________________________________________________________________________________
HEALTH CONCERNS: (explain) ____________________________________________________________________________________________
____________________________________________________________________________________________

SIGNATURE: __________________________ DATE:______________

Completed application can be faxed to 819-647-2845
Mailed to,  Schooner La Revenante Association, Box 700,
Shawville, Qc, J0X 2Y0

Emailed to,  woottonjc@mac.com