Please provide the following contact information:

	Name
	Organization
	Work Phone
	Home Phone
	FAX
	E-mail
	IMPBA#
	URL

Class	Frequency	Alt. Frequency	Entry Fee
AB MONO
AB HYDRO
B TUNNEL
CD MONO
CD HYDRO
E MONO
E HYDRO
F MONO
F HYDRO
SPORT 40
NOVICE
1/8TH SCALE
OPEN CAT
OPEN OFFSHORE
GAS MONO
GAS HYDRO
TOTAL

All check payable to Capitol R/C Model Boat Club Inc.

Mail to payment to:  17245 American Elm Ct Dumfries Va, 22026

Method of Payment: Select one

Personal Check Money Order Pay at race (cash)

Please print this form for your records before you submit.