79th Annual Thanksgiving Regatta

Driver*
Event Date

MonthDayYear
Date
Event Location*
DRIVER
DRIVER Member No.
Driver DOB*
Driver Age*
Driver Club Affiliation
Driver Name*
Driver Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DRIVER EMERGENCY CONTACT*
Emergency Contact Phone*
Present at Race Site?

Present at Race Site?
If not, where?
Helmet Mfg*
Helmet type*

Open FaceFull Face
Life Jacket Mfg.*
Life Jacket Type*

Capsule JacketOther
Allergy*
OWNER
OWNER Member No.
OWNER DOB*
OWNER Age*
OWNER Club Affiliation
Owner Name*
OWNER Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RIDER/CO-DRIVER (if applicable)
RIDER/CO-DRIVER Member No.
RIDER/CO-DRIVER DOB
RIDER/CO-DRIVER Age
RIDER/CO-DRIVER Club Affiliation
Rider/Co-Driver Name
RIDER/CO-DRIVER Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
RIDER/CO-DRIVER EMERGENCY CONTACT
Emergency Contact Phone
Present at Race Site?

Present at Race site?
If not, where?
Helmet Mfg
Helmet Type

Open FaceFull Face
Life Jacket Mfg.
Life Jacket Type

Capsule JacketOther
Allergy
Boat/Driver Qualifications for Kilos or Championship Races (as Required by Division Rules)
Date
Location
Other
Category*
Class*
Boat Number*
Boat Name
Hull Make*
Motor Make*
Cu. In. Disp.
Prototype/Probationary

YesNo
This Entry Blank MUST be filled in with ALL DETAILS and filed with the race committee in accordance with APBA General Racing Rules 3, 4, and 5. Owner and Driver must report immediately to Registration upon arrival at race, present current membership card and have entry checked. Drivers failing to do so and starting in race will not be scored. Entry will not be accepted unless properly signed below.
AGREEMENT OF RELEASE
I represent by my signature below that my Agreement of Release is on file with my current membership, and my membership card number is as shown. I further represent, if I do not possess a current membership card, that I have signed the current Agreement of Release attached with my membership application previously mailed to National Headquarters, or submitted to Registration Officials at the above regatta. In consideration of their promotional efforts on behalf of the sport, I hereby assign all commercial communication and broadcast rights to the American Power Boat Association and do declare them as my lawful agents and representatives regarding such rights. I, the undersigned member participating in events sanctioned by APBA, agree that APBA and its assigns may use my name and picture and pictures of my race boat, or any of them, in any way, medium, or material for promoting, advertising, recording or reporting any APBA sanctioned event before, during and after such event and do hereby relinquish all rights hereto for these purposes.
REQUIRED LEGAL SIGNATURES
Driver Phone Number
Please enter a valid phone number.
Driver Email*
example@example.com
Owner Phone Number
Please enter a valid phone number.
Owner Email*
example@example.com
Rider Email
example@example.com
Name under 18
Parent/Guardian Phone
example@example.com
Email
example@example.com
List any sponsors
Payment Method

Pay at race site (cash, check, cc)Pay Now by Credit Card

Fees

Should be Empty:

DRIVER

OWNER

RIDER/CO-DRIVER (if applicable)

AGREEMENT OF RELEASE

REQUIRED LEGAL SIGNATURES

Credit Card