DECLARATION OF RESPONSIBILITY

OWNER / SKIPPER DETAILS

Yacht Name *

Sail number *

Reference ID *

Name of Owner/Skipper (as in passport) *

I am the (please tick) *

Owner Skipper

Country Mobile Code: *

Mobile number: *

Email: *

ROYAL AWARDS CEREMONY

Prize will be collected by *

Substitute Award *

(Name and country of person on your crew who will accept any prize won at the Royal Awards Ceremony.)

IN CASE OF EMERGENCY

Crew Member (On Water) Contact (Name as in passport) *

Country Mobile Code: *

Mobile *

Emergency (On Land) Contact (Name as in passport) *

Country Mobile Code: *

Mobile *

DECLARATION OF RESPONSIBILITY (please tick)

I hereby acknowledge that the organizing authority and its officers, members and volunteers do not accept any liability for loss of life, personal injury, loss or damage to property caused by or arising out of the Regatta and that I will compete entirely at my own risk and responsibility.

I agree to be bound by the Racing Rules of Sailing, the Sailing Instructions, and the Notice of Race. In particular, I confirm that I have read the Notice of Race and accept its provisions and agree that my boat will conform to the requirements set out in the Notice of Race throughout the event.

I confirm that the Boat is adequately covered by appropriate third-party liability insurance to at least a minimum amount of 1,000,000 USD or equivalent, and declare that such cover is and will be maintained in full force throughout the Phuket King's Cup Regatta. A copy of the insurance documents should be present if requested.

I declare that the owner of the yacht gives me permission to race in the Phuket King’s Cup Regatta.

I hereby release all rights to exhibit these photographs in print and electronic form publicly or privately. I waive any rights or interest I may have to control the use of identity or likeness in the photographs and agree that any use described herein may be made without compensation or additional consideration of me.

Sign

Date