Pasadena Senior Olympics - Swim Entry

SWIMMING ENTRIES            Printer Friendly Version All Swimming participants must complete this form as well as the Official Entry Application. Submit both forms with your entry and registration fees. If you are a member of United States Masters Swimming, place a copy of your 2003 membership card in the upper right corner of the form below and complete all other information. Non-USMS swimmers need only complete the personal information. PLEASE REGISTER ME FOR THE FOLLOWING SWIMMING EVENTS: ADVANCED DIVISION - $5.00 per event

FREESTYLE: BACKSTROKE: BREASTSTROKE: BUTTERFLY: I.M. (4 strokes)

___ 50M (#102) ___ 400M (#93) ___ 50M (#100) ___ 50M (#94) ___ 50M (#96) ___ 200M (#99)

___ 100M (#98) ___ 100M (#95) ___ 100M (#103) ___ 100M (#101)

___ 200M (#150) ___ 200M (#104) ___ 200M (#97)

___ GRANDPARENT/GRANDCHILD RELAY (#144) - No Charge
Name of "Grandchild" _____________________________________ Age ________

NOVICE DIVISION - $5.00 per event

FREESTYLE: BACKSTROKE: BREASTSTROKE: BUTTERFLY: I.M. (4 strokes): MIXED FREE RELAY:

___ 25 Yd. (#105) ___ 25 Yd. (#107) ___ 25 Yd. (#111) ___ 25 Yd. (#113) ___ 100 Yd.(#109) ___ 100 Yd.(#114)

___ 50 Yd. (#110) ___ 50 Yd. (#112) ___ 50 Yd. (#106) ___ 50 Yd. (#108)

TOTAL SWIMMING FEES DUE: $ ___________

USMS Swimmers:          Place copy of card here Name ________________________________ Street _________________________________________________ City ___________________ St. ___ Zip _______ Phone ____________ Age ______ Birthdate _____________ Sex ______

 

Event & #	Est. Time	Event & #	Est. Time

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