Oct 26, 2019 Coastal [email protected] workshop Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country PhoneEmail* Current member of National Women's Sailing Association Yes US Sailing Members Coastal [email protected] Workshop Fee Price: $225.00 Quantity: $225 for US Sailing members. Includes: eight-hour session, access to US Sailing on-line Coastal [email protected] course, testing and certification by US Sailing, and lunch. Non-US Sailing Members Coastal [email protected] Fee Price: $235.00 Quantity: $235 for non US Sailing members. Includes: One year membership in NWSA, eight-hour session, access to US Sailing on-line Coastal [email protected] course, testing and certification by US Sailing, and lunch. Total $0.00 Waiver & Release In consideration of your accepting my registration form and fee, I agree to the following: I will comply with all safety procedures and instructions including, but not limited to wearing a personal flotation device at all times while near or in the water. I release the NWSA, Women’s Sailing Foundation, US Sailing, Cruising Club of America their respective members, volunteers, sponsors, agents or committee personnel from any and all liability for any injury to me or facilities arising out of my participation in this event and all social events connected therewith, whether such loss is due to property damage including but not limited to gear, personal injury or loss of life, even if such loss or injury is due to the negligence of any party so released. I assume all risk of accident, loss of property including but not limited to loss of gear and personal injury or loss of life arising out of my participation in this event and use of facilities. I do hereby irrevocably consent to and authorize the use and reproduction by the Women’s Sailing Foundation and/or National Women’s Sailing Association, or anyone authorized by the Women’s Sailing Foundation and/or National Women’s Sailing Association, of any and all photographs taken of me in all forms and media and for any purpose whatsoever without further consideration.Agreement* By checking this box, you agree to the terms outlined in this waiver and release form. CAPTCHANameThis field is for validation purposes and should be left unchanged.