print this form, or register on the WEB

Sail Number______________Boat's Name______________________________

Class or Design___________________________________________________

If racing under PHRF handicap, enter rating_____________________________

Skipper's Name______________________________

Date of Birth___________ (Juniors only)

Address_____________________________________________________

City________________________________State______Zip__________

Phone (H)___________________________(W)_________________________

Fax_____________________ E-mail_______________________

Member of ___________________________________________________Club

US SAILING Member? ___Yes ___No. If yes, Member #_________________

Event(s) Entered__________________________________________________

________________________________________________________________

Program: (check one)
____Puget Sound Large Boat Program
____Lake Washington
____Puget Sound One-Design Program

Fee(s) for Events Entered: $_________________________________________

Payment (check one) ____Check enclosed  ____Charge my Visa, Mastercard or Discovery Account

Credit Card Number_________________________________Expires____/____

Signature_____________________________________ Date_______________

Mail FAX or deliver to:
   Corinthian Yacht Club of Seattle
  7755 Seaview Avenue NW, Pier S
   Seattle, WA 98117

   Phone: (206) 789-1919      Fax: (206) 789-5896