Everett, WA Entry Blank

Entry Blank
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.
Driver Information
Driver Name *
Driver APBA Member No. *
Date of Birth *

Month Day Year
Date
Driver Age *
at the first day of the sanction for this event
Club *
Emergency Contact
Emergency Contact Name *
Emergency Contact Phone Number *

Area Code Phone Number
Is the Emergency Contact Present at the Race Site?

Yes No
If not, where?
Helmet Style *

Open Face Full Face
Helmet Mfg. *
If your manufacturer is not listed, please choose 'Other'
Life Jacket Mfg. *
If your manufacturer is not listed, please choose 'Other'
Allergy *
Type 'None' if the driver has no known allergies
Category and Class Registration
Category *
Class *
Class *
Class *
Class *
Class *
Class *
Category-Class
Boat# *
Boat Name
Hull Make *
Motor Make *
Cu. In. Disp. *
AGREEMENT OF RELEASE

Please review carefully
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 *
Driver Phone *

Area Code Phone Number
Driver Email *
example@example.com
Owner Name
Owner Phone

Area Code Phone Number
Owner Email
example@example.com
Check 'Yes' below if the driver will be under 18 years of age on the first day of the sanction for this event.

Yes No
Parent/Guardian
For drivers under 18 years of age, parent signature is required
for (Name) under 18
Email
example@example.com
Select how you would like to imprint your APBA card *

I have a picture of my APBA card already saved on my computer I am on a mobile device with a camera and can take a photo I will need to do it at the race
Upload Card Image
Make sure the member information is visible
Select how you would like to imprint your CLUB card *

I have a picture of my club card already saved on my computer I am on a mobile device with a camera and can take a photo I will need to do it at the race
Upload Card Image
Make sure all information is visible
Would you like to register for another class? *

Yes No
By submitting this entry you agree to the terms and confirm your digital identity with the address of your device below.
If a photo of your APBA card is supplied, you will have to hit "submit" twice to allow the entry to go through.
Should be Empty:

Entry Blank

Category and Class Registration

AGREEMENT OF RELEASE

REQUIRED LEGAL SIGNATURES

If a photo of your APBA card is supplied, you will have to hit "submit" twice to allow the entry to go through.