OFFICIAL ENTRY FORM

New England District Championships

Dartmouth College, Hanover NH

March 22 - 24, 2002

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 @ $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

193 Stonecrest Ave.

White River Junction, VT 05001-9454

(802) 295-8976

mary.gentry@hitchcock.org

ENTRIES ARE DUE TUESDAY MARCH 12, 2002

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: ____________