Winter Distance Meet
EBAC
Annual Distance Swim Meet
Name of Team
________________________________Abbreviation ____________
Team Address ________________________________Phone__________________
_________________________________
_________________________________
Coach
______________________________
Phone (day time)_________________ (night
time)____________
Contact Person
_______________________________
Phone (day time)____________ (night
time)____________
2nd Contact Person___________________________
Phone (day
time)______________ (night
time)____________
NUMBER OF ENTRIES:
Female distance
_______X
$4.00= ______________
Male distance
________ X
$ 4.00=_______________
TOTAL =_______________
* For hand written entries ADD .50
to above prices!
Entry deadline:
Make check payable to:
Mail check and ALL entries to:
Roger D. Mooney
Any swimmer, whose entry is
accepted, will for himself/herself, his/her heirs or executors and
administrators waive and release any and all rights and claims for damages
he/she may have against United States Swimming, New England Swimming, East Bay
Aquatic Club, East
Providence High School, the City of East Providence or any of their officers
for any and all injuries suffered by him/her at said meet.
_____________________________________
Authorized Club Officials Signature
Name_________________________________
Title__________________________________
go to Master
Entry Form |