AGE
GROUP AND SENIOR "A/B/C" MEET
TEAM ___________________________________CLUB
ABBREV.______________
ADDRESS
________________________________PHONE_____________________
CITY ___________________________STATE ________ZIP
CODE______________
COACH _______________________________PHONE (H)
__________(W)__________
CONTACT _____________________________PHONE (H)
__________(W)__________
MAIL ENTRIES TO : Cheryl Fletcher
22 Gunn Rd.
Southampton, MA 01073
E-MAIL ENTRIES TO:
Fletchcows@aol.com
MAKE CHECKS PAYABLE TO : Easthampton Barracudas
Swim Team
ENTRY DEADLINE: January 7, 2002
ENTRY FEES: _______Boys Indiv.
Events X $2.50 each = __________________
_______Girls Indiv. Events X $2.50 each = __________________
_______Distance
Events X $ 4.00 each = ______________
HAND ENTRIES :______Boys Indiv. Events X
$3.00 each = _________________
______Girls Indiv. Events X $3.00 each = __________________
______Distance Events X $ 4.50 each =
______________
TOTAL ENCLOSED_________________________
NAMES OF CERTIFIED OFFICIALS WISHING TO HELP:
________________________________________PHONE________________________
________________________________________PHONE________________________
________________________________________PHONE________________________
________________________________________PHONE________________________
Any swimmer whose entry is accepted will for
himself, his heirs, executors, and administrators, waive and release any and
all rights and claims for damages he may have against United States Swimming,
New England Swimming, Easthampton Barracudas Swim Team, and White Brook Middle
School for any and all injuries suffered by him at said meet.
__________________________________
Club Official Signature
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