| 2009 Jammin� on the James Poker Run
July 11th, 2009 Starting at Jordan Point Marina, Hopewell, Virginia Name ___________________________________ Phone _______________________ Address ___________________________ City ______________State ____ Zip ____ Boat Name _____________________________ Year _______ Length _________ Boat Make _________________________________________ Beam _________ Email ________________ FAX _______________ Indicate what your anticipated cruising speed will be during the event: Under 65 mph? Over 65mph? Prizes: 1st Place $1,000.00 2nd Place $500.00 3rd Place $250.00 4th Place $150.00 In consideration of The Richmond Power Boat Association (RPBA) accepting this application, the undersigned for myself, my heirs, executors, administrators, and assigns hereby release and agree to indemnify and hold harmless RPBA, their affiliates, sponsors, organizers, committee officials and each of their respective servants, agents or employees from any claims, demands, damages, actions or causes of action arising out of or in consequence of any loss, injury, or damage to my person or property incurred from any cause whatsoever, in consequence of attendance or participation in the Run event notwithstanding that any such loss of injury or damage may have arisen by the reason of, including but not limited to the negligence of RPBA, their sponsors, organizers, and committee officials or any of their respective servants, agents, or employees. And the undersigned further agrees to hold the said RPBA, their sponsors, organizers, affiliates, and committee officials harmless and does hereby indemnify them from any and all liability for personal injury or property damage to third parties which may occur in any manner arising out of my attendance at or participation in the said event. The undersigned further acknowledges that the event is not a race and that speed in no way determines the outcome of the event, and hereby agrees to abide by any and all rules, directives, terms and conditions of the event as set forth by any of the organizers and/or committee officials, either verbally or in writing, before or during the event. The undersigned further agrees to abide by all state and federal laws and that the boat named in the application for entry is in safe operating condition and complies with and meets and is equipped with the prescribed equipment and requirements of the Small Vessels Regulations of The United States Coast Guard. Captain Signature _______________________Print Name _______________________ Crew ________________________________ Crew _____________________________ Crew ________________________________ Crew _____________________________ It is imperative that the names of the crew members be included on this application. THE DEADLINE FOR ENTRY IS June 26th, 2009!! A late fee of $50 will be charged for all entries after this date. You must make your own Hotel reservations by calling the Renaissance at 757-673-3000. Tell them you are with Richmond Power Boat Association to get a special rate of $129/night. If a room is booked under a name that does not appear on an entry form it will be cancelled prior to the Run. The RPBA will be making your slip reservations for you. Please calculate your slip charge and include it with your registration payment. Registration fee worksheet: Boat plus Captain & first mate __________ x $350 = __________ Number of additional crew ______________ x $150 = __________ Number of additional T-Shirts ___________ x $20 = __________ Slip Fee: Boat length ____ x $1.75 per foot = __________ Please check here if you MUST have shore power ____ ? Late fee $50 (if submitting registration after June 26th, 2009) __________ Your Total Registration Fee (Make all checks to RPBA) Total __________ Please check here if you will require a slip Friday night at Jordan Point (not included in entry fee) ______ T-Shirt Sizes: (Please indicate quantity below) Extra T-Shirts are $20 each. Small _____ Medium ________ Large _______ X-Large _____ XX-Large ___________ Please return this form, proof of insurance, and your Total Registration Fee to: RPBA 251 Four Islands Trail Lanexa, VA 23089 Registrations are not valid until the registration fee is received. |