Kingston Sailing Club Commodore: John Stephenson E-mail: [email protected] Phone: (845) 255-2343 Race Committee Chairman: Dave Wightman E-mail: [email protected] Phone: (845)594-5073 Race Registration Form 2015 Name: _________________________________________________ Home Phone: ________________Cell Phone: _________________ Address: ____________________City:____________ ZIP: _______ E-mail address: _____________________________________ Type of membership: Active ($ l25) _____ Associate ($25) ______ Yacht Name: ______________________ Sail Number:__________ Yacht Make & Model: ________________________ Year: _______ Hull & Deck Colors: _______________________ LOA: _________ PHRF rating: ____________ Fleet (Spin or J&M):______________ Marine Insurance Carrier:__________________________________ Amount of Liability Insurance: $__________________ Effective Dates of Current Coverage: _____________to__________ In consideration of the acceptance of my membership in the Kingston Sailing Club (KSC) and as a condition of my participation in any race or related activity sponsored by KSC, I hereby waive all claims which I may have against KSC and its respective officers, directors, members, committees, employees, agents, or sponsors, arising out of or in anyway connected with my participation in any race or related activity sponsored or undertaken by any of them. I will inform my insurance underwriter of this waiver and inform all crewmembers of any yacht, which I sail in any race or activity, of their responsibility for safety and I will keep my liability insurance current. I agree that this waiver is binding on my heirs, representatives, successors and assigns. Signature: ____________________________ Date: ________________, 2015 Signature: ____________________________ Date: ________________, 2015 NOTE: Please return this form with payment to our Treasurer: Renee Stanley, 124 Creek Side Drive Shandaken, NY 12480 E-mail: [email protected]