Centreboard Entry Form

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Time Trial Amendment 28-8-10

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Centreboard Entry Form

2010-11 SoPYC Centreboard Season

Owner and Skipper Information

Each Owner or part owner and skipper to provide information
Name of Skipper *
Skipper Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Skipper Date of Birth * / DD / MM YYYY
Skipper Email *
Skipper Home Phone * (##) #### ####
Skipper Business Phone (if applicable) (##) #### ####
Skipper Mobile Phone *
Skipper SoPYC Membership Number *
Skipper Yachting Australia Silver Card Number *
Skipper Parent/Guardian Name (If under 18)
Skipper Parent/Guardian Contact Phone numbers
Skipper Medical Alerts

Please list any medical conditions the Club should be aware of.
Crew Information
Crew Name
Crew Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Crew Date of Birth / DD / MM YYYY
Crew Email
Crew Home Phone (##) #### ####
Crew Business Phone (if applicable) (##) #### ####
Crew Mobile Phone (Do not enter spaces)
Crew Membership Number
Crew Yachting Australia Silver Card Number
Crew Parent/Guardian Name (If under 18)
Crew Parent/Guardian Contact Phone Numbers
Crew Medical Information

Please list any medical conditions the Club should be aware of.
Emergency Contact
Your Emergency Contact must be aware of when you are competing and be contactable.
Name of Emergency Contact *
Relationship *
Address *
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Contact Phone Number (Do not use Spaces) *

Emergency Contact should be someone who the Club can contact in the event of your being involved in an accident either on the Club Grounds or on the water.
Boat Information
Name *
Owner *
Sail Number *
Class * Pelican Silver Pelican Gold Optimist Laser 4.7 Laser Radial Laser 420 Skate 125 Flying Fifteen
Identification
Hull Material *
Topsides Colour *
Deck Colour *
Description of easily distinguised feature/graphics
Storage Application for 2010-11 Season * Pelican ($71.50 Shed) Optimist ($71.50 Shed) Laser ($112.50 Shed, $87.00 Grass) 420 ($87.00 Grass) Skate (112.50 Shed) Flying Fifteen (Land Pen Fees Apply) No Storage Required
Insurance Details
Insurer (Please choose one from the list) *
If Other, please specify.
Policy Number *
Date of Expiry * / MM / DD YYYY
Third Party Liability (Please choose an option) *
Racing Support

Are any of your family or friends available to assist by volunteering to help with your racing?
Name/s
Area of Interest Galley Support Boat Sunday Start Team
Sailing is a sport that involves interacting with the uncontrollable and difficult to predict elements of nature, and therefore involves a degree of risk. Many of the risks inherent in the sport are intuitive. Your attention is drawn to the following:
Declaration To be completed by each nominated skipper. * I have received the Notice of Race and Sailing Instructions provided by SoPYC in connection with my nomination to race. I have obtained a copy and read the ISAF Racing Rules of Sailing with particular reference to the YA Special Prescriptions I consider I am competent by my knowledge and experience to skipper the boat and i understand my obligations to my crew if applicable and other competitors The boat has valid insurance, including but not limited to 3rd party insurance of at least $10,000,000 and that the policy will be kept current The boat complies and will be maintained in compliance with the requirements of the YA Special Prescriptions and Class Rules My attention has been drawn to ISAF Racing Rules of Sailing, Rule 4, which states: "Decision to Race - The responsibility for a boat's decision to participate in a race or to continue racing is hers alone"

Centreboard Entry Form

Owner and Skipper Information

Crew Information

Emergency Contact

Your Emergency Contact must be aware of when you are competing and be contactable.

Boat Information

Identification

Insurance Details

Racing Support

Sailing is a sport that involves interacting with the uncontrollable and difficult to predict elements of nature, and therefore involves a degree of risk. Many of the risks inherent in the sport are intuitive. Your attention is drawn to the following: