Manchester Swim Team

Manchester LCM Invitational Swim Meet

Raco Pool, Manchester NH

July 2-4, 2010

CONTACT INFORMATION
Team Name:			Abbreviations:
Deck Coach:		Phone:	Email:
Entries Contact:		Phone:	Email:

Address:
City:
State:		Zip Code:

ENTRY FEES
Individual Electronic Entries (less than 800)	@ $5.00 =
Individual Non-Electronic Entries (less than 800)	@ $5.50 =
Individual Electronic Entries (800 and 1500)	@ $7.00 =
Individual Non-Electronic Entries (800 and 1500)	@ $7.50 =
Relay Electronic Entries	@ $15.00 =
Relay Non-Electronic Entries	@ $15.50 =
Per Swimmer Surcharge	@ $5.00 =
	Total:

Make check payable to: Manchester Swim Team

Mail entries and check to:	Entry Deadline: June 23, 2010
Manchester Swim Team	For e-mailed entries, this form and payment
c/o Rhonda Farrington, Entry Chairperson	must be received within four business days
3 Ledgewood Road
Bedford, NH 03110
	Email: mst@farrington-berg.com

LIABILITY RELEASE
Any swimmer whose entry is accepted will, for him/herself, his/her heirs, executors and administrations, waive and release any and all rights and claims for damages he/she may have against United States Swimming, New England Swimming, Granite State Swim Association, Manchester Swim Team and the City of Manchester for any and all injuries suffered by him/her at said meet.

____ The undersigned team certifies that all athletes in the entry are registered with USA Swimming.
____ The undersigned team is including an official certificate of insurance.

____________________________________
Signature of Authorized Team Official	Date