Skipper Name_______________________________Birthdate_____________
Address________________________________________________________
City,State,Zip____________________________________________________
Telephone _____________________E-Mail____________________________
Crew Name_________________________________Birthdate_____________
Address________________________________________________________
City, State, Zip__________________________________________________
Telephone No.__________________Email____________________________
Tee Shirt Size: Skipper___________Crew ____________________________
Yacht Club Affiliation______________________________________________
Sail Number_________________Hull Color____________________________
Boat Name______________________________________________________
Distance Traveled to SCYC_________________________________________
Fees Collected:
Entry Fee ($110.00) 				___________
Late Fee ($20.00) (Sat July 19th) 		___________
Mariner Class Dues ($15.00) 			___________
Sat. Social additional People ($15.00/Person) 	___________
Total Collected					___________
First Time Skipper at Mariner Nationals YES_______NO______
Official Liability Waiver and Release 
	to be signed at Check-In.__________
Date: ____________Skipper Signature_______________________________
Date: ____________Crew Signature _________________________________

This official Entry form accompanied by a check made out to 
SCYC for the appropriate fees should be mailed in advance to: 
	Bill D’Autrechy 372 4nd Street,
	Surf City, New Jersey 08008 (Phone No. 609 494 3016)