Albemarle Hospice Regatta and Party

 

Registration Form

 

August 7, 2010

 

Skipper’s Name:___________________________________________________________________

 

Address:_________________________________________________________________________

 

City:________________________________State:________________Zip:_____________________

 

E-mail:______________________________Phone:_______________________________________

 

Cell:(______)_________________________Yacht Club:___________________________________

 

Make:_______________________Model:____________________________Length:_____________

 

Boat Name:_________________________ Sail Number:__________ PHRF Rating:_____________

 

Class:  (circle one)

 

             Big Boat Race:

 

             (1) Spinnaker             (2) Non-Spinnaker    (3) Cruising

 

             Small Boat Race:

 

             (1)Youth Sunfish        (2) Youth Open          (3) Adult Sunfish        (4)Adult Open

            

Lien Waiver

This Regatta will be governed by the International Yacht Racing Rules, the prescriptions of USYRU, including the prescription

to rule 76.1. The undersigned hereby assumes all risk of accident and expressly agrees that the Albemarle Hospice Regatta and the Pasquotank River Yacht Club will not be liable, under any circumstances, for loss or injury to participants or others, loss or damage to any yacht. The undersigned further agrees to indemnify and hold the Albemarle Hospice Regatta and the Pasquotank River Yacht Club and its officers free and harmless under, from and against any and all losses, costs, damages, attorney’s fees and liabilities of any kind or nature whatsoever, growing out of or resulting from participation in this event.

 

Signature of Owner/Skipper or Parent/Guardian (for youth under the age of 18) (circle one):

 

____________________________________________________________________________Date:_________________

 

REGISTRATION: Includes one dinner/party ticket, one t-shirt, skipper’s gift bag (shirt size______)           $50.00

                                                                                                                                                                                           ($40 before July 25^th)

 

DINNER/PARTY TICKETS:              ____________      @          $25/Each                                       =            ______________

 

T-SHIRTS: @ $18.00 Each                                                                                                                                 =            ______________

                 Youth L ___ Adult S____ Adult M____ Adult L____ Adult XL____ Adult XXL____

Entry fee will be returned if unable to attend.                                                                                                     TOTAL=        ____________

                     

MAKE CHECKS PAYABLE TO:                                   

ALBEMARLE HOSPICE REGATTA

P.O. Box 278

Camden, NC  27921

or fax to: (252) 331-2390 & pay at registration