OFFICIAL ENTRY FORM
NORTH COUNTRY AQUATIC CLUB TEAM SPECIALTY MEET
DARTMOUTH COLLEGE, HANOVER NH NOVEMBER 3-4, 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 *	=	__________
__________	Relay Entries @ $7.00 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:
Lori Dickerson PO Box 351 254 Runnals Rd (if using Fed Ex) Hartford, VT 05047
(802) 295-6268 LoriSDickerson@aol.com

ENTRIES ARE DUE TUESDAY, OCTOBER 23, 2001

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