Entry Form

Please complete this form inBLOCK LETTERS. For boaters, attach the completed form along with a copy of validboat registration & insurance, PPCDL or equivalent and valid 2016 IRC certificate. For windsurfers, attach the completed form along with a copy of valid Level 1 Windsurfing Proficiency certification, or the PA Basic Certification or equivalent. You may either fax to +65 6862 2280, email to or mail/ deliver to "Dock Master - Raffles Marina" before 17 July 2016. Entries received after 17 July 2016 will be charged an additional $50.00.

Helm’s Particulars

Name of Helm: ______RML M’ship No: ______

Home Address: ______

______

Nationality: ______NRIC/Passport No.: ______

Email Address: ______Club Representing: ______

Tel No. (Office): ______Tel No. (Mobile) : ______

Emergency Contact Name / Number : ______

Description of Yacht

Name of Yacht: ______Sail No.: ______

Design of Yacht: ______Flag / MPA Reg.: ______

LOA: ______Beam : ______Draft : ______

For Trimarans, Catamarans& SB20 Class,please refer to payment details (1). For IRC A, B, PY & J/24 Class, please refer to payment details (2).For Windsurfing, please refer to payment details (3).

Class completing in / IRC A / IRC B / PY / J/24 / SB20 / Multihull / Formula Windsurfing
(please tick 1)

Advertisement details (if applicable): ______

______

For Windsurfing only (please tick 1):

4.0m2 Novice (Women) / 4.0m2 Novice (Men) / 4.7m2 Intermediate (Women) / 5.5m2 Intermediate (Men) / 6.2m2 Intermediate (Mixed) / 7.8m2NeilPrydeRSOne Open (Mixed)

Ordering of T-shirts (Please indicate quantity required)

For your ordering convenience, the chest measurements for the t-shirts are provided below.

Complimentary T-shirts for PAID Participating Skipper & Crew
XS (36”) / S (38”) / M (40”) / L (42”) / XL (44”) / XXL (46”) / Total

Payment Details (1)

For Catamarans, Trimarans, and SB20 Classonly

Boat Entry Fee (inclusive skipper): ______x S$ 200.00=S$ ______

Crew Fee (per person): ______x S$ 50.00=S$ ______

Additional Reception Entry(15 Aug 2015): ______x S$ 30.00=S$ ______

Additional Reception Entry(16 Aug 2015): ______x S$ 30.00=S$ ______

Additional Reception Entry(22Aug 2015): ______x S$ 30.00=S$ ______

Sub-Total=S$ ______

Add 7% GST=S$ ______

Grand Total=S$ ______

Payment Details (2)

For IRC A, B, PY & J24 Class only

Boat Entry Fee (inclusive skipper): ______x S$ 300.00=S$ ______

Crew Fee (per person): ______x S$ 50.00=S$ ______

Additional Reception Entry(15 Aug 2015): ______x S$ 30.00=S$ ______

Additional Reception Entry(16 Aug 2015): ______x S$ 30.00=S$ ______

Additional Reception Entry(22Aug 2015): ______x S$ 30.00=S$ ______

Sub-Total=S$ ______

Add 7% GST=S$ ______

Grand Total=S$ ______

Payment Details (3)

For Windsurfing only

Windsurfer Entry Fee: ______x S$ 50.00=S$ ______

Additional Reception Entry(15 Aug 2015): ______x S$ 30.00=S$ ______

Additional Reception Entry(16 Aug 2015): ______x S$ 30.00=S$ ______

Additional Reception Entry(22Aug 2015): ______x S$ 30.00=S$ ______

Sub-Total=S$ ______

Add 7% GST=S$ ______

Grand Total=S$ ______

Payment Mode (Please tick where applicable)

Raffles Marina Membership Account
Credit Card Payment
Visa / Mastercard / American Express
CVV No : ______

Name of Card : ______Expiry Date : ______

Card No:
Cheque Payment (Made Payable to Raffles Marina Ltd)

Cheque No : ______Amount : S$ ______

Declaration

I, and on behalf of my crew, hereby acknowledge that the Singapore Sailing Federation, Raffles Marina, Singapore Management University, Regatta Sponsors and their representatives, officials, members and volunteers do not accept any liability for any loss of life or property, personal injury or damage to property caused by or arising out of this Regatta and that I compete entirely at my own risk. I agree to be bound by the MPA regulations, ISAF Racing Rules of Sailing 2013 – 2016, the Notice of Race, Sailing Instructions, the rules and prescription therein referred to and all amendments thereof.

Name of Owner/Skipper/Windsurfer: ______Signature & Date: ______

For Windsurfing only:

For parent/guardian (below 21 years old)

I, ______, parent/guardian of ______(aged 21 and below) hereby unreservedly acknowledge that in allowing my child/ward to participate in the competition, I agree to fully accept full responsibility and liability, and I, my estate and/or personal representative, shall have no claim, whatsoever, direct or consequential, against the OA, Singapore Management University, SMU Sailing Club, SMU Windsurfing Club, Constant Wind Pte Ltd, Raffles Marina Ltd, the race officials, the committee or the jury, the sponsors, and other officials responsible for any damages, loss or injury, either ashore or on the water, either to persons or equipment, which may result from participation in the races.

Name of Parent/Guardian: ______Signature & Date: ______

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