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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. 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: $ ___________
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USMS Swimmers: City ___________________ St. ___ Zip _______ Phone ____________ Age ______ Birthdate _____________ Sex ______ |
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