KSC Racing Series Registration 2015

Kingston Sailing Club
Commodore: John Stephenson
E-mail: fatjohnz28@gmail.com
Phone: (845) 255-2343
Race Committee Chairman: Dave Wightman
E-mail: dawightms@yahoo.com
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: renee499@msn.com