PVAC Senior Development Meet
Sanctioned
by: New England Swimming, Inc. No.
NE-02-16
Please answer all questions and sign where requested to sign:
Team__________________________________________________
Address________________________________________________
Zip Code _______________ e-mail address if cuts are made_________________
If results go to a different e-mail address, please add this.
.....................................................................................................................................
MAIL
ENTRIES TO: Isabelle Fraser
125
Franklin Rd.,
Longmeadow, Ma. 01106 Phone 413-567-3415.
Make
checks payable to: PVAC
Entry
Deadline: Wednesday, Dec. 26,
2001. If you use express mail, please
take
the time
to sign the waiver, so it may be left.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Entry Fees:
________Womens Ind. Events x $2.50 =_________
________Womens Dis. Events x $4.00=__________
________Mens Ind. Events x $2.50=__________
________Mens Dis. Events x $4.00=__________
Total $_________
..................................................................................................................................................
Any swimmer whose entry is accepted, will, for himself, his heirs, executors, and administrators, waive and release any, and all rights and claims for damage he may have against United States Swimming, Inc., New England Swimming, Inc., Pioneer Valley Aquatic Club, and Springfield College for any and all injuries suffered by him or her at said meet.
______________________
_________
Signature of Club Official
Date
Names of Volunteer Officials
Certification Level
Phone Number
_____________________ _____________ ____________
_____________________ _____________ ____________