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Name *

First Name

Last Name

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Address

Address 1

Address 2

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Birthdate

MM

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Spouse, Partner, or Other Household Adult Name

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Emergency Contact Phone number *

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When would you be interested in sailing?

Weekday Evenings (after 5 pm)

Weekday Daytime

Weekends

We hold club races every Sat. morning (mostly Thistle class) during our sailing season. Would you be interested in joining our racing program?

Yes

No

Date

MM

DD

YYYY