I agree to comply with the rules and regulations of each of the host clubs, US SAILING, and other rules under which this race or series is sailed. I agree to indemnify and hold host clubs and SCYYRA, their Officers, directors, and committeemen harmless of any liability of any nature whatsoever for accident or injury to myself, my guests, and/or boat, while racing or engaging in any activities related to or connected therewith.

I certify that I am able to swim. I agree to abide by the decisions of the race and protest committees. I further agree not to sail in hazardous conflict with commercial shipping.

Skipper_____________________________________

Address_____________________________________

City/State/Zip________________________________

Yacht Club______________________________________

M F Birth Date___/___/___ T -Shirt Size _____

Home Phone_______________________________

Fax ______________________________________

US Sailing #_________________________________ Laser Class Membership # ____________________

Skipper Signature______________________________________________________

Date______________________

Parent/Guardian Signature (if under 18) _____________________________________

Date______________________

Entry fee of $20.00 is enclosed Please make check payable to: SCYYRA