Print out and mail to Class Secretary below

New _____ Transfer______ Class of Boat Victoria
Manufacturer's Hull Number _____________
Manufacturer's Name ______________________ Or If Home Built Please Check Here _____
Club Affiliation Name ______________________________________
AMYA Membership # ________________
If this is a transfer: Purchased from: _____________________________________________
Sail # ___________
My name is: ___________________________________
Address: ______________________________________
City __________________________________________ State_______ Zip Code: __________
Telephone ( __ __ __ ) __ __ __ - __ __ __ __
E-Mail ____________________________________________
Each Registration or transfer is $10.00 U.S.
Make Payable to the Class Secretary.

Class Secretary
Name: Ronald  (Ron)  Stephanz
Address: 21 Broadmoor Lane
City/St/Zip: Rotonda West, FL 33947
Cell: 256 617-1584