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Saturday 2nd September 2017

Cookham Regatta

Entry Form for Dragon Boat

A crew of ten paddlers plus Drummer is required (Total 11).  Boat, paddles and an experienced helm will be provided.
Entry fee £100.
Additionally where a completed entry form and appropriate fee is received by Thursday 27 July 2017 an ‘Early Bird Discount’ of £10 may be deducted.
Please note: Entry to the Regatta enclosure for race entrants is included in the race entry fee
Non race entrants must pay separately at the entrance on arrival; £5 adult, £1 child, £10 family
Start time for the regatta will be 10.00am  If your team has a good reason for avoiding the first few heats then please show your earliest available time below.

Crew name

Club/Organisation (if applicable)

Earliest start time

Reason

Contact details

First contact

Name

Address

Phone landline

Phone mobile

Email address

Second contact

Crew details

First name

Last name

  Age if under 18

 Other events entered

Captain

Crew 2

Crew 3

Crew 4

Crew 5

Crew 6

Crew 7

Crew 8

Crew 9

Crew 10

Drummer

Payment details

Dragon Boat entry fee £ 100

Early Bird Discount claimed £10 (please tick if applicable)

Amount to be paid (please adjust if necessary)                                 £

If paying by bacs select here and send to:
Cookham Regatta Sort Code 60-13-35  Account No. 67075037  Reference: your Crew Name

If paying by cheque select here and make payable to ’Cookham Bridge Rotary Club Regatta Account’ and write your Crew Name on the reverse then send it to:
Regatta Entries, 31A Victoria Road, Eton Wick, Berkshire, SL4 6LY

If paying by any other means select here and give details

Agreement & Authority

As first contact listed above please tick here to affirm that you have read the Cookham Regatta Rules and Regulations.   


Rules and Regulations

By submitting this form all my crew and I agree to abide by the Cookham Regatta Rules and Regulations. In particular we agree that the race organisers shall not be liable for any loss, damage, death or personal injury howsoever caused as a result of taking part in this event. I confirm that all my crew and I are competent swimmers and I have their authority to enter them into this event and commit them to the above agreement.  I also confirm that I have the written authority of a parent, guardian or responsible person for all crew members under the age of 18 years.

Please enter the text shown and then ‘Submit’

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