Owner
Name (First/Last/Nick):
Address:
City State Zip
Home/Cell/Work/Fax
eMail Address:
Yacht Club(s)
US Sailing Member No:
Skipper
Check if same as Owner:
Name (First/Last/Nick):
Address:
City State Zip
Home/Cell/Work/Fax
eMail Address:
Yacht Club(s)
US Sailing Member No:
Yacht Information
Class
Name of Yacht/Homeport /
Sail Number
Manufacturer/Model
LOA/Beam/Draft
Color (Deck/Topsides/Cabin/Bottom)
Number (Masts/Spreaders)
VHF-SSB Call/Type of Aux Pwr
IRC Rating/Cert # / PHRF Rating/Cert #
Yacht Image (Only .jpg, .gif or .png files)
Waiver