ENTRY FORM
Reserved for CRMT
Inscription reçue le
600 € le
1500 € le
Please write legibly
Country code
Boat number
Skipper - Last name/First name
Boat
Race name
Official name
Serie :
Prototype :
Model
Designer
Year of construction
Year of construction
Skipper
Man
Woman
Nationality
Date of birth
DD/MM/YYYY
Address (street / city / state / country)
Home phone
Mobile phone
+ country dialling code
+ country dialling code
Email
Sailing licence number
Club
S
Clothes size
M
L
XL
XXL
contact ashore during the race
Last name / First Name
Mobile phone
Home phone
+ country dialling code
+ country dialling code
Email
Relationship
Entry form
(edited 23/11/2016)
Page 1/2
COMMITMENTS AND OBLIGATIONS
I undersigned certify that the information given on this entry form are true and given in good faith and I ask to enter, the
2017 Mini-Transat, with the following boat :
certificate of registration boat’s name :
under sail number :
and with race name :
I declare to accept and assu me t he ent i re responsabi l i ty of al l dama ges and /or acci den t that could occu re due
to the ship condition or due to t he materi al on board , and t hat the boat has com p leted al l sa fety requ irements
requi red by govern ment au t hori t i es or by spor t aut hor i ti es.
I declare that I have read t he 20 17 Mi ni -Transat Not i ce of Race, and accep t i t wi thout reser ve. I declare to have
read the paragraph on sai lors responsab i l i ty, and to have the qual i f i cati on , abi l i t i y and necessar y sai l ing sk il ls.
Wi th the presen t declarat i on, I release of any reponsabi l i ty the associ at i on Col lect i f Rochelai s M i n i Transat ,
the organ ising clu b, t he French Sai l i ng Federat i on ( FFVoi le) , t he sponsors and par t ners of t he regatta , t he
members of the Race Commi t tee, J u r y and Measuremen t Com m i t tee and any natural and legal person which
take part to the 2017 Mi ni -Transat organi sat i on . I wi l l cover any and al l con ti ngenci es d ur i ng the en t i re du rati on of my participat i on i n t he regat ta .
If, i n case of Force Majeu re, t he 20 17 Mi ni -Transat does not occur, t he associ ati on Col lect i f Rochelai s Mini
Transat and/or its col laborators and sponsors wi l l not be responsi ble for dama ge and loss suf fered .
MINI-TRANSAT 2017 COMPLETE FILE WILL INCLUDE :
- 2 100 € for entry fees (600€ at registration + 1 500€ before the 1st of July 2017)
- This entry form completed and signed with mention «read and approuved»
- Medical file completed
- Sent to Classe Mini all necessary documents and meet the Classe Mini qualification requirements
Signed in:Date :
with mention
«read and approuved»
Entry fees payment by cheque or bank transfert
- 600€ entry fees, non-refundable, must be joigned to this entry form
- 1 500 € to register to 2017 Mini-Transat before the 1st of July 2017
Collectif Rochelais Mini Transat
Pôle France Voile
Avenue de la Capitainerie
17000 La Rochelle
France
Banking transfert (send us a proof of the bank transfer)
Account holder ASSOC. COLLECTIF ROCHELAIS MINI TRANSAT
Account number 56010755439
Institution code 11706
Sort Code 44030
IBAN FR76 1170 6440 3056 0107 5543 934 BIC (SWIFT) AGRIFRPP 817
Entry form
(edited 23/11/2016)
RIB Key 34
Page 2/2