Name:

Address:

City:

State:

Zip:

Home Phone:

Work Phone:

Cell Phone:

Email:

Sailing Experience?

Members,  $175                                                                   Non Member,  $275

 __Charge to my ILYC account                                    __Check enclosed

__Charge to my credit card***                                     __Charge deposit to my credit card***

VISA/MASTERCARD #______________________________________***  EXPIRATION_____________ AMOUNT_____________         

*** If you are going to email registration, please call us with your credit card number as this

                    PDF is not encrypted.

Signature_________________________________________________                                

Mail or Email Registration to:     Ida Lewis Yacht Club, Adult Program, P.O. 479, Newport, RI 02840

                                                      Or email ILYC@ILYC.org In the Subject Line please type: Adult Registration