skipper's name___________________________________________________
Address________________________________________________________
City______________________________State_____Zip__________________
Boat Name______________________________________________________
Number of crew__________Sail Number__________________
1998 PHRF Rating_______________Class/type of boat___________________
Day Phone________________Yacht Club Affiliation______________________
ENTRY FEE IS $50.00.
For Credit Card payment
Card Type________________Exp Date______
Card Number___________________________________________________
Amount__$_____________
Signature____________________________________________
or enclose check payable to the Leukemia Society
Send Fee and Registration to
Leukemia Society of America
2030 Westlake Ave
Seattle WA 98121
phone: (206) 628-0777