NOTE:   We will NOT accept this form WITHOUT PAYMENT.

If you have paid by or will pay by check or cash, please check this box.            
 Name on Check and Check Number, if known 

You will be directed to PayPal immediately after submitting this form. You do not need a PayPal account to use the PayPal feature. you have the option to use your credit card information at the PayPal site. (NCWSA never sees your credit card information)

In consideration of being allowed to participate in the activities and programs of the North Coast Women’s Sailing Association (NCWSA) and Edgewater Yacht Club (EWYC), I agree and acknowledge as follows:

I, , am in good health and physically able to participate in the activities and programs of the NCWSA. I agree to abide by the rules and regulations of the NCWSA, EWYC, the Sailing Instructions, and any other applicable rules and regulations of affiliated organizations and sponsors, including but not limited to all policies regarding sportsmanship, fair play and discipline.

I understand that sailing, like all water sports, is a dangerous activity and that wind and weather conditions may be hazardous. The risks and dangers may be caused by my own actions, or inactions, the actions or inactions of others, the conditions in which the programs and activities take place, or the negligence of the Releasees named below. There may be other risks and social and economic losses either not known to me or not readily foreseeable at this time. Participation in the programs and activities of NCWSA and EWYC can lead to injury, including permanent disability and death. I understand it is solely my decision to embark upon, continue or otherwise participate in any particular activity at any time, and is not the decision of NCWSA. I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES I may incur as a result of participation in NCWSA and EWYC’s programs and activities.

I, for myself and my executors or administrators, heir and assigns, HEREBY RELEASE, discharge, and covenant not to sue NCWSA and EWYC, their administrators, directors, agents, officers, volunteers and employees, other participating organizers, any sponsors, advertisers, and if applicable, owners and lessors of any watercraft, sailboat or powerboat on which NCWSA programs and activities take place, (each considered one of the Releasees herein) from all liability, claims, demands, losses or damages caused or allege to be caused in whole or in part by the negligence of the Releasees or otherwise, including negligent rescue operations; and I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement, I, or anyone on my behalf, makes a claim against any of the Releasees, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS each of the Releasees, from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as a result of such claim.

I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed it freely and without any inducement or assurance of any nature and intend it be a complete and unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be invalid, the balance, notwithstanding, shall continue in full force and effect.

2013 STATUS

Have you been assigned/invited/accepted to a racing/prep team for the NCWSA 2013 Season?     No        Yes        Maybe

If YES, what is the Boat OR Skipper's Name? Comments

2013 NCWSA MEMBERSHIP FORM

First Name: Last Name Is this a new name (from what we have)?    No        Yes

Email: (required) Is this a new email (from what we have)?    No        Yes

Please create a password (4-10 characters, combination of lower and upper case letters and numbers)

Address:

City: St: ZIP:

Home Phone: Work Phone: Cell Phone:

Team Responsibility: By signing this form, each team member on a boat agrees to the responsibility of taking care of the boat. If any damage or loss of an item(s) occurs while on the boat, including at the dock, each team member is responsible for her share of the total cost of the damage or item. This includes the cost up to the boat owners’ insurance deductable.

MEMBERSHIP DEMOGRAPHICS

Company Name Occupation

How many years have you been sailing? Racing?     NCWSA Member? New     Current     Former

Are you a member of EYC? Yes    No         Are you a member of another Sailing Club?

What is your age? over 60    50-59    40-49    30-39    21-29    18-20

Please select a committee on which to serve: Education      Merchandising      Public Relations      Racing     
Membership      Newsletter      Website/Internet      Social      Fundraising       Regatta

MEDICAL EMERGENCY INFORMATION

Emergency Contacts

Name    Relation

Home#    Bus./Cell#

Name    Relation

Home#    Bus./Cell#

  North Coast Women’s Sailing Association • PO Box 771502 • Lakewood, Ohio 44107 • www.ncwsa.net