FORD OPEN AND NATIONAL CHAMPIONSHIPS by jolinmilioncherie

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									                     End of Season Optimist Championships
                                (Gorman Trophy)
                               National Yacht Club
                              2nd & 3rd October 2010

                                 ENTRY FORM
1.   Senior Fleet     Gold              Silver                                          €50
     Junior Fleet     Gold              Silver                                          €50
     Regatta Fleet                                                                      €50
     Late Entry       (received after 30th September)                                   €20
     Discount         10% for subsequent sibling entries

2.   I enclose a cheque made payable to The National Yacht Club for €
     or
     Please debit my Visa, Laser, Mastercard

     Name _________________________              Expiry Date: ____/____


3.
     Name:                                              Date of Birth:
     Address:                                           Sail No
                                                        Club:
                                                        Tel No
                                                        Mobile No:
     email                                              (during the event)

4.                                                          IODAI Member             Y/N
     Sailor's Signature:

5.   DECLARATION.
     I accept full responsibility my son/daughter's safety. I agree to waive any claim for
     loss, damage, or personal injury against I.O.D.A.I., the National Yacht Club and any
     individual or body concerned with this event, and I agree to indemnify I.O.D.A.I.,
     The National Yacht Club Club and any such individual or body concerned against
     any such claim that may be brought by or on behalf of my daughter / son. I also
     declare that I hold an adequate & valid Third Party Insurance Policy of not less than
     €1,500,000 which covers my daughter / son whilst taking part in this event.
     Signed:                                                                 (parent/ guardian)
     Name
     (Capitals)

     Date:

6.   POST ENTRIES TO: The Sailing Manager, National Yacht Club, Dun Laoghaire, Co.
     Dublin. (Fax: 01 2807837) Email sailing@nyc.ie

								
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