OFFICIAL ENTRY FORM

OFFICIAL ENTRY FORM

Hobie Sprint Series 2009

Nedlands Yacht Club

Skipper

First Name:

     

Last Name:

     

Address:

     

City:

     

State:

     

Country:

     

Postal Code:

     

Telephone:

     

Fax:

     

E-mail:

     

Date of Birth:

     

Club:

     

Hobie Assoc:

     

Crew

First Name:

     

Last Name:

     

Address:

     

City:

     

State:

     

Country:

     

Postal Code:

     

Telephone:

     

Fax:

     

E-mail:

     

Date of Birth:

     

Club:

     

Hobie Assoc:

     

Boat Details

Sail Number:

     

Boat Name:

     

Sponsor/Product:

     

Events

H16 Youths |_|

Womens |_|

Masters |_|

Grand Masters |_|

H16 Open |_|

Fees

$50

Payment

Amount Enclosed: $      

Release and Indemnity Agreement

I agree to be bound by The Racing Rules of Sailing (RRS) and all other rules that govern this event. I agree that none of the organisations, persons involved in the running of this event, sponsors, promoters, class association or any other involved persons or parties accepts liability for damages due in negligence or any other reason whatsoever while conducting or connected with this event for injury, to property or person, I may suffer while participating in the event and while upon the event premises. I know the risks of danger to myself and my property while preparing for and participating in the event, and while upon the event premises, relying upon my own judgment and ability, assume all such risks of loss and hereby agree to reimburse all costs to those persons or organizations connected with this event for damages incurred as a result of my negligence.

Skipper signature

Crew signature

I certify that I hold third party liability insurance to a minimum value of $AUD 5 million in accordance with the Notice of Race.

Skipper signature

Please forward completed form and fees to:

Steve Sturgeon or

Taylor Booth

Enquiries

E-mail: taylor- boothy_05@hotmail.com

Steve- Stevesturgeon@live.com.au

Event Website:http://www.hobiesprintseries.com

Amount received: $     

Paid by: Cash |_| Cheque |_|

Receipt No:      

Initials      

Official use only

HCAWA 2009-10 Nationals ENTRY FORM 090203.docPage 1 of 18/10/2009