Captain John Piper Regatta - 21 & 22 July 2018

Entry Form

Yacht Club / Team Name:

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code / Zip

Country

Team Phone Number

Team Email

Team Information

Skipper Details

Date of Birth

World Sailing ID

Governing Body No.

Medical Information

Allergies

Medication

Past Injuries

Emergency Contact

Name

Relation

Phone

Crew Details

Name

Date of Birth

Governing Body No.

Medical Information

Allergies

Medication

Past Injuries

Emergency Contact

Name

Relation

Phone

Crew Details

Name

Date of Birth

Governing Body No.

Medical Information

Allergies

Medication

Past Injuries

Emergency Contact

Name

Relation

Phone

Crew Details

Name

Date of Birth

Governing Body No.

Medical Information

Allergies

Medication

Past Injuries

Emergency Contact

Name

Relation

Phone

Crew Details

Name

Date of Birth

Governing Body No.

Medical Information

Allergies

Medication

Past Injuries

Emergency Contact

Name

Relation

Phone

Coach (if any):

Payment Options

Regatta entry fee - $550.00 AUD Note: Credit Card details will be taken for the Damage Deposit of $600.00

Payment Options

Invoice

Wire Transfer

Credit Card (Please note a 2% fee is charged on all credit card transactions that exceed A$500)

Invoice To: (if different from previous address)

Account Name: Cruising Yacht Club of Australia

Bank Details: Westpac, Sydney

SWIFT: WPACAU2S

BSB - 032 000

Account No. - 291078

Reference: "Event Name" - "Yacht Club" entry fee

Credit Card Details

Card Type

Name on Card

Card Number

Expiry

CCV

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to be bound by World Sailing Racing Rules of Sailing and all other rules that govern this event. I specifically acknowledge RRS Fundamental Rule 4 which states: “The responsibility for a boat’s decision to participate in a race or to continue racing is hers alone.”