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Bellingham Yacht Club
2011 Dale Jepsen One Design Regatta Registration
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| Skipper |
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Address
City
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State
Zip
Country
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| Phone |
Email
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| Sail Number |
Type
Other Type
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| Yacht Club |
Age at time of Regatta (Opti/Youth)
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Crew Names
(name, phone
& email |
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Event
Waiver:
In consideration for participating in this event, I represent
to its organizers that my yacht has liability insurance
currently in effect, covering property damage, personal
injury and death in an amount not less that $300,000 per
occurrence, and that the policy covers yacht racing activities.
I acknowledge that the decision to enter my yacht and crew
to participate in this event is solely my own; and I agree
to be bound by the International Yacht Racing Rules as adopted
by US Sailing, including national prescriptions, except
as modified by the organizers, and the race notice for this
event. I further agree to hold harmless the Bellingham Yacht
Club, its officers, representatives or race committee for
damages or losses which I or anyone on my boat may incur
which are associated with my participation in this event
and related activities.
By completing this section I accept the above statement:
Full Name:
Date:
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Parent/Guardian Approval/Waiver:
I,
, the parent or guardian of the Applicant, agree on behalf of my child/ward
to hold harmless the Bellingham Yacht Club, its Directors, Officers, Members,
the Sailing Foundation, the City of Bellingham, the Instructors, or anyone
else connected with this program from any claim arising from any injury my
child/ward may suffer in the course of participating in this Junior Sailing
Program, and I hereby authorize the Junior Sailing Program Leaders, Employees,
Volunteers, Organizers, and/or other Bellingham Yacht Club personnel to sanction
emergency treatment for the Applicant if none of the above persons (Parent/Guardian
or Emergency Contacts) can be reached.
I accept the above statement:
Parent/Guardian full name:
Date:
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REGISTRATION FEES
Single Handed ($40)
Double Handed ($60)
Crewed 3 or More ($75)
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Early Registration Discount (by 9/10 @1700 hrs)
Take $5 Discount
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TShirts $12/ea
Qty: @ $12 - TShirt Sizes Please List (S, M, L, XL, XXL)
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| TOTAL: |
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| Payment Method: |
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Credit Card/Online via GoogleCheckout
Mail in a check*
Pay at the door*
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*Checks must be received by discount date, pay at door is late registration, no discounts apply! |
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