2005 Fall Harvest and Lightship Race Registration Form

Skipper's Information

(First name):______(Last name):______

Address: ______City: ______State:_____ Zip: _____

Yacht Club Affiliation:______

Telephone ______Email:______Fax:______

What is the best way to reach you? ______

Boat Information

PHRF-ME 2005 Handicap (attach cert):_____ Yacht Name: ______

Yacht Type (eg: J/29): ______Rig: ______LOA: ______Sail Number:______

Color: ______Crew Weight Limit ______Crew Number Limit: ______

Division entered (circle one):

Racing Novice O/D

Entry Fees

Fall Harvest Regatta Entry Fee $30.00$______

Lightship Race Entry Fee $30.00$______

DISCOUNT: Fall Harvest & Lightship Regatta Entry Fee

together $50 ($20 savings until 9/16 only!!!)$______

TOTAL AMOUNT ENCLOSED OR CHARGED$______

Method of Payment

1) Checks (Please Make Payable to Portland Yacht Club).

2) Credit Card VISA/MASTERCARD Card# ______Exp Date ______

Cardholder Name ______

3) Charge my PYC Membership #:______

TURN OVER & COMPLETE WAIVER

Portland Yacht Club Fall Harvest Regatta and Lightship Race 2005 Participant’s Waiver and Release

I understand that the decision to participate in any event during the Fall Harvest Regatta and the Lightship Race is my sole responsibility and not that of the Portland Yacht Club. In consideration of being permitted to participate in the Regatta, on behalf of myself, my heirs, executors, administrators, successors, and assigns I herby waive, release and discharge any and all claims, actions, causes of action, and suits whatsoever, in law, admiralty, or equity against the Portland Yacht Club and each of its officers, directors, employees, and agents (collectively as “Releases”) resulting from or arising out of my participation in the Fall Harvest Regatta and the Lightship Race.

I further acknowledge that participation in the Regatta involves substantial risk of personal injury and even death which can only be minimized through preparation and training and a continuing evaluation of the conditions under which a race is started and continued, all of which are my sole responsibility. I accept full responsibility for such preparation, training, and evaluation of conditions and specifically release and discharge Portland Yacht Club from any duty to provide such preparation, training, and evaluation to or for me and assume all risk of injury and other damage associated with participation in the Fall Harvest Regatta and/or the Lightship Race.

I have carefully read this waiver and release of Liability, and I understand and agree to its contents and have knowingly executed it for the purposes recited therein.

Boat Name ______

Name of owner ______

Signature ______

Date ______

COMPLETE AND MAIL OR FAX TO:

Portland Yacht Club

Attn: Race Committee
40 Old Powerhouse Road
Falmouth, Maine 04105
Tel (207) 781-9820 Fax (207) 781-4559