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Top O` Michigan - Entry Blank
August 8-9
Indian River, MI
Top O` Michigan Marathon Nationals
Registration Deadline: Friday, July 31
Each person must have their own registration form. If you need to register for multiple people please click the link to submit another entry once you have submitted the first one.
**If at any point you feel help is needed please email apbahq@apba.org any time or call 586-773-9700 M-F 8:30-5:00pm ET.
Entrant Information
First Name:*

Last Name:*

Email*

Date of Birth*

MM/DD/YYYY
Age*

Club Affliliation*

APBA Member #*

Is this person a minor?*
Yes
No

APBA Member Card and Club Card- Image Upload
 
Both cards in one image please
Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Emergency Contact Information
In Case of Emergency Contact:*

Phone Number*

At Race Site?*
Yes
No

If no, where?

Safety Information
Helmet Mfg.*


Full Face
Open Face

Life Jacket Mfg.*


Other
Capsule Jacket

Allergies*

Type "N/A" if you have none
CLASS REGISTRATION
Class Information
# Days Racing
Total
Category - Stock Marathon
Class
Q
T
Boat #*

Boat Name

Hull Make

Motor Make

Cu.In. Disp.

Prototype/Probationary?
No
Yes

Would you like to register for another class?
Yes
No


Category - Stock Marathon
Class*
Q
T
Boat #

Boat Name

Hull Make

Motor Make

Cu.In. Disp.

Prototype/Probationary?
Yes
No

Would you like to register for another class?
Yes
No


Category - Stock Marathon
Class*
Q
T
Boat #

Boat Name

Hull Make

Motor Make

Cu.In. Disp.

Prototype/Probationary?
Yes
No

TRAILER REGISTRATION
Trailer
Fee
# of boat trailers
Total
Boat Trailer Fee
CREW
In order to abide by social distancing guidelines, each driver may bring three (3) crew members into the pit area. Please list them here in order for them to gain admission.
Crew Member 1

Crew Member 2

Crew Member 3


AGREEMENT OF RELEASE
I represent by my signature below that my Agreement of Release is on file with my current membership, and my membership card number is as shown.
I further represent, if I do not possess a current membership card, that I have signed the current Agreement of Release attached with my membership application previously mailed to National Headquarters, or submitted to Registration Officials at the above regatta.
In consideration of their promotional efforts on behalf of the sport, I hereby assign all commercial communication and broadcast rights to the American Power Boat Association and do declare them as my lawful agents and representatives regarding such rights.
I, the undersigned member participating in events sanctioned by APBA, agree that APBA and its assigns may use my name and picture and pictures of my race boat, or any of them, in any way, medium, or material for promoting, advertising, recording or reporting any APBA sanctioned event before, during and after such event and do hereby relinquish all rights hereto for these purposes.

Entry will not be accepted unless properly signed.
Entrant Signature:*

Dated*

Parent/Guardian if under 18*

Dated*

Release and Waiver of Liability
I acknowledge reading and agree to the terms of the Release and Waiver of Liability*

Minor Releases must be completed at race site with a legal guardian.
Total
Grand Total:
YOU MUST PAY AT RACE SITE
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