I am the owner and/or skipper of (name of vessel) sail no

I wish to enter this vessel into the GOSPORT PENINSULA CHARITY PURSUIT 2016.

The vessel is a monohull catamaran trimaran other

The vessel is a (class type e.g. westerley centaur/moody 27/j24, etc)

The vessel is rigged as a sloop cutter ketch yawl freedom other (specify)

The vessel’s handicap for 2016 is py irc other, (specify)

Gosport Peninsula Charity Pursuit Saturday 21st May 2016

Pursuit Entry Form

or, the vessel has not been measured for a handicap

I require a berth at Hornet for the prize-giving & barbecue yes no

(Limited berthing will be available on a first-come-first-served basis, with priority given to vessels not normally berthed in Portsmouth Harbour)

Entry Fees

Vessel size Now to 31 Jan 2016(Early Bird discount)

From 1 Febto 31 March

From 1 April to 14 May

Vessels up 9.99m LOA £20 £30 £40

Vessels from 10m to 19.99m LOA £25 £40 £50

Vessels over 20m LOA £30 £50 £60

ENTRIES CLOSE AT 1200 on 14 MAY 2016 The Organisers reserve the right to refuse an entry.

Tickets for barbecueI and my crew require a total of tickets for the barbecue @£10 each. Total £

Payment Methods1. By cheque, made payable to Gosport Marine Scene CIC, c/o Halsar Marina, Gosport, PO12 1NU.

2. BACs transfer to: Sort code: 77-91-29, Account no: 4035 6468, Account name: Gosport Marine Scene CIC, Reference: Pursuit 2016.

(Gosport Marine Scene CIC - Gosport Marine Scene is a Community Interest Company, registered number 08478820.)

LEGAL LIABILITY (to be signed by the vessel Owner/Skipper)1. By completing and paying for an entry for the Gosport Peninsula Charity Pursuit 2016, I/we agree that I/we accept the Conditions of Entry and further accept that I/we are responsible for ourselves, our crew and our vessel, whether ashore or afloat.

2. No action or omission by The Organisers: i.e. The Organisers, their Management Team, Patrol Craft and anyone helping to run the Event, will relieve me/us, as participants, of my/our responsibilities.

3. By putting to sea, I/we imply the suitability of my/our vessel and the competence of the skipper and crew for the expected or forecast conditions. My/our safety and that of my/our crew is my/our responsibility, including the decision to sail in the conditions on the day.

4. I/we understand The Event Organisers shall not be liable for any loss, damage, death or personal injury howsoever caused to the owner/entrant, the skipper or crew, or vessel as a result of my/our taking part in the Gosport Peninsula Charity Pursuit. Moreover I/we, as owner/skipper, warrant the suitability of the entered vessel for the event.

OWNER of the vessel entered SKIPPER of the vessel entered

Signature

Name

Address

Post code

Tel

Mobile

Email

Sponsorship

Name and address of chosen charity*

Registered Charity Number

Name and contact details of Head of Fundraising

*If more than one chosen charity, please provide similar information for all of them.

PLEASE RETURN THE COMPLETED ENTRY FORM TO: peter.newell47@btinternet.com

Gosport Peninsula Charity Pursuit Saturday 21st May 2016

Pursuit Entry Form