OFFICIAL ENTRY
FORM
New England
District Championships
Team Name: |
__________________________________ |
Abbreviation: |
_____________ |
Coach: |
__________________________________ |
Daytime phone |
_____________ |
|
(coach on deck at meet) |
Evening phone |
_____________ |
Name
and Address of the person to receive ALL
communication including entry questions, timing assignments and meet results:
Name |
_______________________________________________________________ |
|
Address |
_______________________________________________________________ |
|
City/Town |
|
Zip ____________ |
Daytime Phone |
_________________________________ Evening Phone |
_______________ |
E-mail |
_________________________________ |
|
ENTRY FEES
__________ |
Individual
Entries @ $3.00 per event * |
= |
__________ |
__________ |
Distance (400, 500,
1650) @ $5.00 per event * |
= |
__________ |
__________ |
Relay Entries (@ $7.00 per relay |
= |
__________ |
|
Total payable to
North Country Aquatic Club |
|
__________ |
__________ |
Individuals in Meet
at @$1.00 each |
= |
__________ |
|
Total payable to New
England Swimming |
|
|
* Individual entry fees increase 50¢ to $3.50
if not submitted on disk or via email as part of a
.sd3 or .cl2 electronic file.
OVERNIGHT MAIL or EMAIL TO:
Mary
Gentry
(802)
295-8976
mary.gentry@hitchcock.org
ENTRIES
ARE DUE
If sending entries via email, the check and paper copy must
arrive within 48 hours of the email entry.
Any swimmer whose entry is accepted will, for himself, his heirs, executors, and administrators, waive and release any and all rights for damages he may have against United States Swimming, New England Swimming, North Country Aquatic Club, and Dartmouth College and any volunteer or any employee of the above, for any and all injuries or losses suffered by him at said meet.
Signature
of Team Official: __________________________________ Date: ____________