OFFICIAL ENTRY
FORM
NORTH COUNTRY
AQUATIC CLUB TEAM SPECIALTY MEET
DARTMOUTH
COLLEGE, HANOVER NH
DECEMBER 7-9,
2001
|
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 |
_________________________________ State
_______ |
Zip ____________ |
|
Daytime Phone |
_________________________________ Evening Phone |
_______________ |
|
E-mail |
_________________________________ |
|
ENTRY FEES
|
__________ |
Individual
Entries @ $2.50 per event * |
= |
__________ |
|
__________ |
Distance (400, 500,
1650) @ $4.00 per event * |
= |
__________ |
|
|
Total payable to
North Country Aquatic Club |
|
__________ |
* Individual entry fees increase 50¢ to $3.00
if not submitted on disk or via email as part of a .sd3 or .cl2 electronic
file.
OVERNIGHT MAIL OR EMAIL TO:
Mary
Gentry
193
Stonecrest Ave.
White
River Junction, VT 05001
(603)
653-1950 days
(802)
295-8976 evenings
mary.gentry@hitchcock.org
If sending entries on a computer disk or
by email, make sure to enclose a paper copy of the entries as well.
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.
Date Signature
of Authorized Team Official