Local Masters Swimming Committee for North Carolina -- CONSOLIDATED ENTRY CARD

Name __________________________________
 
 Male ___ Female ____ USMS #____-________
Birthdate ___ / ___/ ____ Age _____ Club or Chapter______________ Phone ( ____ )_____ - ________

Event
No.		 FREESTYLE 
(submitted time) 		Event
No.		BACKSTROKE
(submitted time)		 Event
No.		BREASTSTROKE
(submitted time)		 Event
No.		BUTTERFLY
(submitted time)		 Event
No.		INDIV MEDLEY
(submitted time)
 
 
50
:        .		  
 
50
:        .		  
 
50
:        .		  
 
50
:        .		  
 
100
:        .
 
 
100
:        .		  
 
100
:        .		  
 
100
:        .		  
 
100
:        .		  
 
200
:        .
 
 
200
:        .		  
 
200
:        .		  
 
200
:        .		  
 
200
:        .		  
 
400
:        .
 
 
400/500
:        .
Meet:___________________________________________________
No. of Events ______ x $ ________ = $ ___________
Surcharge = $ ___________
Other fees = $ ___________
Total = $ ___________
For Office Use Only
Amt Recvd_______
Date ___________
 
 
800/1000
:        .
 
 
1500/1650
:        .

Include a copy of USMS Card    Signature on form is REQUIRED!    Include a copy of USMS Card

Late or incompleted entries (no fee, incomplete entry card, incomplete entry date) or entries postmarked after date due MAY BE REJECTED!

ALL MASTERS Swimmers are required to send a photo-copy of their current USMS card with their entry. ALL MASTERS Swimmers may be asked to show their USMS card if requested at the meet.

I, the undersigned participant, intending to be legally bound, hereby certify that I am physically fit and have not been otherwise informed by a physician. I acknowledge that I am aware of all the risks inherent in Masters Swimming (training and competition) including possible permanent disability or death, and agree to assume all of those risks. AS A CONDITION OF MY PARTICIPATION IN THE MASTERS SWIMMING PROGRAM OR ANY ACTIVITIES INCIDENT THERETO, I HEREBY WAIVE ANY AND ALL RIGHTS TO CLAIMS FOR LOSS OR DAMAGES, INCLUDING ALL CLAIMS FOR LOSS OR DAMAGES CAUSED BY THE NEGLIGENCE, ACTIVE OR PASSIVE, OF THE FOLLOWING: UNITED STATES MASTERS SWIMMING, INC., THE LOCAL MASTERS SWIMMING COMMITTEES, THE CLUBS, HOST FACILITIES, MEET SPONSORS, MEET COMMITTEES, OR ANY INDIVIDUALS OFFICIATING AT THE MEETS OR SUPERVISING SUCH ACTIVITIES. In addition, I agree to abide by and be governed by the rules of USMS.

PLEASE Sign and Date: _____________________________________________

Is this your first Masters Meet ? Yes ____ No ____

Read the meet information sheet carefully. Make your
check payable as shown on the meet information sheet and
mail it to the address shown

 Non-LMSC for NC swimmers please include your address:

Street: _______________________________

City, State, Zip: ________________________

Please fill in the entry card correctly, getting the Event Numbers from the Order of Events page, and the amounts from the fee section of the Meet Description.

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To return to Swimming in North Carolina's home page.
Date 6/12/98
http://www.NCmasters.org/conentry.html