X-Treme Silkscreen and
Design Inc.
Sponsors
North
Shore
Swim Club Distance Meet
Sunday,
January 13, 2002
Name of
Team: _______________________________
Abbreviation:__________
Team Address:
_______________________________
Phone: ________________
Coach:
_________________________
Phone:
________________ E-Mail: _______________
Contact Person: _________________________
Phone:
________________ E-Mail: _______________
Number of Entries:
(Electronic Entries)
Women
events____________ x
$ 4.00 =
__________
Men events
____________ x
$ 4.00 =
__________
Total =
__________
(Hand Entries)
Women
events____________ x
$ 4.50 =
__________
Men events
____________ x
$ 4.50 =
__________
Total =
__________
Entry
Deadline:
Receive by
January
4, 2002
Make checks payable to:
North
Shore
Swim Club
Mail entries to:
North
Shore
Swim Club
19
Fenley Rd.
Gloucester
, Ma. 01930
Any swimmer, whose entry is accepted will for himself, his heirs or executors
and administrators waive and release any and all rights and claims for damages
he/she may have against United States Swimming , E-Treme Silkscreen and Design
Inc, North Shore Swim Club, or any of their officers or the Salem State College
for any injuries suffered by his/her at said meet.
____________________________________
Authorized
Club Signature
Title : ______________________________