EAST REGION 2015 OPEN WATER CHAMPIONSHIP and AGE
Transcription
EAST REGION 2015 OPEN WATER CHAMPIONSHIP and AGE
EAST REGION 2015 OPEN WATER CHAMPIONSHIP and AGE GROUP COMPETITIONS incorporating County Championships as appropriate (Under ASA Laws & ASA Technical Rules) Whitlingham Outdoor Education Centre, Whitlingham Lane, Trowse, Norwich. NR14 8TR SUNDAY 19thJULY 2015 CLUB DATA CAPTURE FORM The closing date for the entriesis 20thJune 2015. We require your form by to enable us to process the entry in time. SURNAME FORENAMES ASA REGISTRATION NO DATE OF BIRTH SEX (M/F) LATEX ALLERGY Y/N DESCRIPTION OF EVENTS EVENT 1 COST 3k Freestyle (Incorporates Nationals Qualifier ages15&16) Region Age Groups: 13-16 17-19 20-24 25-29 30-34 35-39 40-49 50-59 60+ NOVICE 800m Freestyle – (Swum this event before? See condition 23) EVENT 2 EVENT 3 Age Groups: 11-12 13-14 15-16 17+ 1.5k Freestyle (Incorporates Nationals Qualifier ages 12,13 & 14) Region Age Groups: 12-16 17-19 20-24 25-29 30-34 35-39 40-49 50-59 60+ PLEASE TICK £20 £12 £20 5k Freestyle OPEN CHAMPIONSHIP & AGE GROUP EVENT 4 (Incorporates Nationals Qualifier ages17/18 &19 & over) Region Age Groups: 13-16 17-19 20-24 25-29 30-34 35-39 40-49 50-59 60+ No: Events entered at £12 per event £20 No: Events entered at £20 per event Total payment due £ Submit completed forms with correct money to your club. Cheques should be payable to your club as they will make a bulk payment for all their entries. Please enter me into the ASA East Region Open Water Championships and inform the organisers that I have a latex allergy if I answered Y above. I declare that I am an eligible competitor as defined by A.S.A. law. I have read the document headed East Region Championships2015 Open Water SwimmingConditions, understand the conditions and agree to abide by them. Signature of Competitor ....................................................................... Date .................................................. Signed ___________________________________________________ Parent/Guardian (Swimmer under 18)