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