Skipper/Boat Information:

Skipper Name: ________________________ Boat Hull/Sail Number: _____________

Home Phone: _________________________ Work Phone: _____________________

Address: ______________________________________________________________

E-Mail: ______________________________

Fees:

One of the following:

Early Bird Special: $75.00 _________

Early Bird, Bare Bones: $45.00 _________

Or one of the following:

Day of, Full Course: $85.00 _________

Day of, Bare Bones: $50.00 _________

And additional items:

Additional dinner tickets: $12.00 adults, $3.00 children: _________

US Sailing Members: deduct $5.00 from each package: _________ Mem # _____________

Total Fees: __________

Make Check Payable To: Catawba Yacht Club

Mail Form/Check to: Larry Jordan

PMB 310

13000-F York Rd

Charlotte, NC 28278

Release: I agree to be bound by the Racing Rules of Sailing 2001-2004, the INTERNATIONAL J/22 CLASS ASSOCIATION CLASS RULES and the local club rules and regulations of the event. In consideration of the acceptance of this entry or by my being permitted to take part, I agree to waive all claims against the Catawba Yacht Club, its organizers and its respective agents, officials, and representatives in respect to death, injury, loss or damage to my person or property however caused arising out of or in connection with my taking part in this event notwithstanding that the same may be caused by or occasioned by the negligence of the same bodies or any of them or their agents, officials, or representatives. I furthermore understand and agree that this Release is binding upon myself, my crew, my heirs executors and assigns.

Signature: _________________________________ Date: ____________________