IOA - Huntington Indiana 2025

Racing Registration
This form is used to register for racing at the 2025 15th Annual Harry Brinkman Memorial Regatta in Huntington, Indiana, on 5/31/2025 – 6/1/2025. Full details can be found here: https://www.apba.org/old/internal/print_sanction.php?EditID=13750

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.

You will need to complete this form once for each unique class, just as you would at a race.

Online registration close date is May 28, 2025 at 4pm.

Event Location*

Huntington, IN

Event Date*

5/31/2025 – 6/1/2025

Driver First Name*

Driver Last Name*

Driver Information

Driver APBA Member No.*

Date of Birth*

Date

Driver Age*

at the first day of the sanction for this event

Club*

Emergency Contact

Emergency Contact Name*

Emergency Contact Phone Number*

Area CodePhone Number

Is the Emergency Contact Present at the Race Site?

YesNo

If not, where?

Helmet Style*

Open FaceFull 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*

Junior Class

Stock Class

Modified Class

PRO Classes

Category-Class

Boat#*

Boat Name

Prototype/Probationary*

YesNo

Hull Make*

Motor Make*

Cu. In. Disp.*

Would you like to include owner information?*

YesNo

Owner Name

Owner APBA Member Number

Owner Club

Owner Data of Birth

Date

Owner Age

Owner Phone

Area CodePhone Number

Owner Email

example@example.com

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.

Driver*

Driver Phone*

Area CodePhone Number

Driver Email*

example@example.com

Parent/Guardian

For drivers under 18 years of age, parent signature is required

for (Name) under 18

Parent/Guardian Phone

Area CodePhone Number

Parent/Guardian 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 computerI am on a mobile device with a camera and can take a photoI 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 DRIVER CLUB card*

I have a picture of my club card already saved on my computerI am on a mobile device with a camera and can take a photoI will need to do it at the race

Upload Card Image

Make sure the member information is visible

By submitting this entry you agree to the terms and confirm your digital identity with the address of your device below.

Entry Blank

Category and Class Registration

AGREEMENT OF RELEASE

REQUIRED LEGAL SIGNATURES