JOSEPH CONRAD YACHT CLUB

2007 Race Entry Form for the Joseph Conrad Yacht Club Regatta”

Race Date: August 26th, 2007

Skippers Meeting at 1100 AM, First Start: 12:30 AM

Owner/Skipper: ____________________________________ Yacht Name: __________________________________

Address: _________________________________________ City, State, Zip: ________________________________

Home Phone: ______________________________________ Work Phone: __________________________________

US SAILING Membership Number: _____________________ E-Mail Address: _______________________________

Sail Number: _______________________________________ PHRF Rating: _________________________________

Make or Class: _____________________________________ Hull LOA: ____________________________________

Yacht Club: ________________________________________ Hull Color: ___________________________________

Crew Members: ___________________________________________________________________________________

In consideration of the acceptance of my entry, I hereby agree to be bound by the ISAF Racing Rules of Sailing and all other rules that govern this event. I also agree that my yacht will be equipped and outfitted in accordance with the Notice of Race and that she will have all the required equipment aboard in hull, rig, and sails and that she will be competently manned. I further accept and agree to all of the covenants and instructions and additional sailing instructions concerning this race. As Owner/Skipper, I agree to abide by all conditions of the Race for the Trophy of the “Jozefa Konrada Korzeniowskiego” (“Joseph Conrad Korzeniowski”) and accept full responsibility for the conduct and safety of each member of my crew and guests arising from participation in any of the activities of this Race.

I further acknowledge and agree to waive, release, and discharge any and all claims that I or my representatives may have against the Committee of the Race for Trophy of the “Jozefa Konrada Korzeniowskiego” (“Joseph Conrad Korzeniowski”), the Joseph Conrad Yacht Club, the Sponsors, their Officers, Directors, Members, Employees, Agents, or Volunteers for any damage or injury arising out of my participation in any of the activities related to this Race. I knowingly assume the risks of yacht racing and agree that the decision to start and continue a race is solely my responsibility.

I am registering my boat in the regatta as a (please circle one):

Racing Boat VIP Escort Boat Committee Boat

Owner/Skipper Signature: _______________________________________________ Date: _____________________

Eligibility and Entry

If registering as a racing boat, the Entry Form must be accompanied by:

1. Valid 2006 PHRF Rating Certificate for all boats registering in the Racing Group. If no certificate available the boat will be enter in Cruising Group (please provide boat class, type or approximate handicap rating). A 6 second per mile penalty shall apply to any boat in the Racing Group providing inaccurate handicap ratings.

PLEASE NOTE: The rating certificates are available from Lake Michigan Performance Handicap Rating Federation (LMPHRF)

Certificate of Insurance with a minimum of $300,000 liability coverage through 08/26/2007. Please provide a copy of the declarations page with your application

2. $20.00 check made payable to the Joseph Conrad Yacht Club for the JCYC members, and

$30.00 for non-members.

Your entry will be acknowledged upon receipt.

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Office Use Only

__________ Entry Fee Received __________ Acknowledgement Mailed Date: ______________

__________ PHRF Certificate Received __________Registration Data Entered Entry Number: _______