You may register on-line at:  http://www.clwyc.org/LaserMidwintersEast05/reginfo.php

Name  ______________________________________________

Address  ____________________________________________

City, State, Zip ______________________________________

Day Phone Number ___________________________________

Evening Phone Number _______________________________

ISAF Sailor ID _________________________________________

Club Affiliation ________________________________________

Sail Number __________________________________________ Class legal sail numbers only (see NOR)

Gender (M/F)_________________________________________

Fleet:    Laser      Radial     4.7      (circle one)

Age Category:    Junior (<17)          Open (17-34)                    Apprentice Master (35-44)
                               Master (45-54)     Grand Master (55-64)     Great Grand Master (65+)       (circle one)

The entry Fee is $120 USD with a $30 late fee after February 10, 2005. This includes lunch each day, 2 dinners and a regatta souvenir.

Please make checks payable to Clearwater YC - Youth Sailing and mail to:
Clearwater Yacht Club
Attn: Laser Midwinters East
830, South Bayway Blvd
Clearwater, FL 33767