MS. DARLENE MCGRATH
45 TRUMAN DR.
RANDOLPH, MA 02368
SOUTH SHORE YMCA STRYPERS
TEAM DISTANCE MEET
JANUARY 6, 2002
NAME OF TEAM:___________________________________ ABBREVIATION:_____________
TEAM ADDRESS:___________________________________ PHONE:_____________________
COACH:___________________________________________ PHONE:_____________________
CONTACT PERSON:_________________________________ PHONE:_____________________
TEAM E-MAIL ADDRESS: (required)_________________________________________________
NO. OF ENTRIES:
BOYS:_______ X $4.00 = ______
GIRLS:_______ X $4.00 = ______
SURCHARGE:_______ X $ .50 = ______ (required for hand entries)
TOTAL = ______
| ENTRY DEADLINE: DECEMBER 21, 2001 |
| MAKE CHECK PAYABLE TO: YSS SWIM TEAM |
| MAIL ENTRY & CHECK TO: MS. DARLENE MCGRATH 45 TRUMAN DR. RANDOLPH, MA 02368 |
ANY SWIMMER WHOSE ENTRY IS ACCEPTED WILL FOR HIMSELF, HIS 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, SOUTH SHORE YMCA STRYPERS SWIM TEAM AND THE SOUTH SHORE YMCA FOR ANY AND ALL INJURIES SUFFERED BY HIM/HER AT SAID MEET.
________________________________________________
AUTHORIZED CLUB OFFICIAL'S SIGNATURE
NAME:__________________________________________
TITLE: __________________________________________
| PLEASE LIST CERTIFIED OFFICIALS FROM YOUR CLUB |
| NAME:__________________________ PHONE:____________________________ |
| NAME:__________________________ PHONE:____________________________ |
| NAME:__________________________ PHONE:____________________________ |