Winter Specialty Meet

EBAC

  Annual Winter Swim Meet

February 1, 2 & 3, 2002

 

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 ______________X  $2.50= _____________

Female distance _______ X $4.50= ______________

Male_______________  X $2.50=_______________

Male distance ________  X $ 4.50=_______________

        TOTAL         =_______________

 

Entry deadline: Tuesday, January 29, 2002

 

Make check payable to:

East Bay Aquatic Club

 

Mail check and ALL entries to:

Roger D. Mooney

113 Lindy Avenue

Riverside, RI. 02915

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__________________________________