Event On-line Pre-Registration Form

MERRIMAC REGATTA

May 26, 2012   10:00AM  Entry fee $20.00
 

Make your check payable to PBC and mail along with the signed

Waiver of Liability Agreement

to:

Portsmouth Boat Club

PO Box 162

Portsmouth, Va. 23704

or

bring payment and Waiver Agreement to the skippers meeting.

 Use the TAB key to navigate between entry cells

* - indicates a required field entry

Merrimac Regatta Online Pre-Registration By submitting this information, I certify that this boat/yacht conforms in everyway to Class Rules and Measurements. For other classes, any applicable certification is on file with the Class Representative, Host Club, or will be provided to PBC Race Committee at the Skippers meeting. I agree to abide by all the rules established for the event and I release the City of Portsmouth and Portsmouth Boat Club its officers, directors, sponsors, employees and volunteers from all liability by reason of injury, harm or damage to my vessel or myself or my guests and crew. I also acknowledge that registration is not complete until payment and signed Entry Form and Waiver of Liability Agreement is received by the Portsmouth Boat Club race committee.
First & Last Name* *
Sail Number
Boat Name
Class
Portsmouth Rating (If known)
Boat Type (Make & Model)* *
Boat Length* *
Hull Color* *
Club Affiliation
Street Address* *
City* *
State* *
Zip Code* *
Contact Phone No.* *
Email Address* *
Additional Lunch Tickets	Two tickets are included with registration. Indicate only the number of additional tickets desired.
Comments/Questions
I agree to the above statements ->* *	Yes
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