Event:
Date of Incident
Event Name
Sponsoring Yacht Club
Event City     Event State
Body of Water
Was this day or night?
Air Temperature?      Water Temperature?
What was the wind speed?       Wave height?

Victim(s):
Name
Boat Name     Boat Length
Boat Make & Model     

Name
Boat Name    Boat Length
Boat Make & Model

Name
Boat Name     Boat Length
Boat Make & Model     

Name
Boat Name     Boat Length
Boat Make & Model

What position(s) was/were the victim working before they went in?

Was a PFD worn by the victim(s) Y/N?
What Type (Victim 1)?
What Type (Victim 2)?
What Type (Victim 3)?
What Type (Victim 4)?

We award one-medal per boat, yet wish to acknowledge the participants individually for the rescue.  Please provide the names of the participants from each boat in the rescue: 

Rescuing Boat #1
Skipper's Name
Skipper's Phone Number
Skipper's E-mail Address
Crew's Names and function each performed in the rescue:

Boat make and model
Boat Name     Boat Length

Rescuing Boat #2
Skipper's Name
Skipper's Phone Number
Skipper's E-mail Address

Crew's Names and function each performed in the rescue:

Boat make and model
Boat Name     Boat Length

What Happened?

What was the nature of this Incident?
What happened?:

Overboard Specific Questions

What recovery method was used (Quickstop, Reach Method, Figure 8, etc)?

Did the victims boat lose sight of the victim?
What search pattern was used?
Was GPS or other electronic MOB function used to track or help locate the victim Y/N?
    
Where there any difficulties with the electronic locater?

Was a rescue swimmer put in the water Y/N?
Did the victim have a strobe light, a light or whistle?
What color clothes were visible above the water?
Was the victim able to help in the recovery Y/N?
In what way?

How did the victim get hoisted from the water level up onto the deck?

Was any injury sustained by the victim Y/N?     
What type (hypothermia included)?

Was a Lifesling aboard Y/N?     Was it used Y/N?
How much time did the victim spend in the water?

Outside Assistance

Did a Mayday call go out?
Who responded?

ISAF & US SAILING Special Regulations

Was the race sailed under the International Sailing Federation Special (equipment) regulations Governing Offshore and Oceanic Racing including US SAILING Prescriptions Y/N? 
If so, which category (Category 0, 1 2, 3, 4, or 5)?

Nominator's: 
* - Required Fields
* Name
* Address
* City  * State   * Zip Code 
* E-mail Address 
* Phone 
* Your Birth Date mm/dd/yy
(Note - We need any date, not necessarily your birth date to stop the spam we are getting.  Thank you.)
Do you give permission to have this story published Y/N?
Can you provide copies of articles published about this event Y/N?

Announcement:
Some nominators wish to keep the nomination secret, as a surprise for the potential recipients.  If you desire a surprise, we will issue the press release the next business day after the medal is presented.  Our experience has shown that immediate notification to the sailing world receives a better response from the sailing public, than a surprise.  It is your call, and we will follow your wishes.