Benefiting The Pungo District Hospital Foundation Event Registration Regatta Entry Fee $35 ($45 after June 27) $_______ Shoreside Pass $35 x _______________ (Capt.’s Reception, 2 breakfasts, Happy Hour, & Buccaneer Bash) $_______ Regatta T-Shirts @ $15 ea ($16 for XXXL) Men’s: M ____ L ____ XL ____ XXL ____ XXXL ____ $_______ Women’s: S ____ M _____ L _____ XL _____ XXL_____ $_______ Total $_______ Please charge my Visa____ MC____ Discover____ #____________________________________ Exp._______ Skipper or Owner _________________________________ Address _________________________________________ City _____________________ State______ Zip _________ Phone: Day (________) ____________________________ Evening (________) _______________________________ Email Address ___________________________________ Yacht Name _____________________________________ Type ________________ Length ______ Sail #__________ Registering in: Dinghy Racing _____ Multihull Class _______ PHRF Classes: Spinnaker _______ Non-Spinnaker _______ Classic Boat _______ Cruising Class _______ NC-PHRF Rating _______________ Club____________________________________________ I release Pungo District Hospital Foundation, the River Forest Manor, and the event organizers of all liability for injury to person or property during my participation & my crew’s partici- pation in this regatta and associated events. Signature_____________________________Date_______ Make Checks Payable to: PDHF - Pirates on the Pungo Mail To: Pirates on the Pungo Regatta P.O. Box 707 Belhaven, NC 27810 PO Box 707 Belhaven, NC 27810