Region 3

CENTRAL FLORIDA US12M CHAMPIONSHIP REGATTA

Registration form

Sponsored with the cooperation of

Sebring Lakeshore MYC and Suncoast MYC

Make check Payable to: Judy Fox
Send check & form to: Judy Fox, 6802 CR17 So., Sebring, FL 33876

For information call 863-655-2979 or email rcfritze@strato.net

Registration form must be received by November 11, 2008

Name _________________________________ Phone #__________________________

Street Address___________________________Email Adr._______________________

City __________________ ___ _ State__________________Zip _____________

AMYA # _______________SAIL # ______________ Radio MFG.______________

Transmitter Make ____________________________

It is suggested you have 3 FREQUENCIES AVAILABLE #1 ________ #2________ #3_______ 2.4GHZ ________

All boats must have sail numbers on the main and the jib

Amount enclosed: $_____________ Entry fee - $25.00 Extra guest - $5.00 (non-refundable)

In consideration of accepting this entry, I hereby for myself, my heirs, executors, and administrators , waive and release any and all rights to claim damages that I may have or acquire against the Sponsor Clubs, or its members, the sailing site owners, employees, agents, representatives, or assigns, and the American Model Yachting Association, or its members, from any claim for injury or other damages to me or my family during this regatta’s events.

Signed: _______________________________ Date:_______________________