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Date:

Country/State Represented

National Sailing Authority affiliation or association :

Name of Blind Sailing Organization :

Contact Person:

Mailing Address:

Email address:

Telephone:

Fax:

Membership fee $US50.00

We request that this form be printed and faxed to:

Peg Hawkins, Treasurer, Blind Sailing International at: 617-969-6204.

Once this has been done, Peg Hawkins will contact you and arrange settlement.