New England 12 & Under Short Course Championships

Hosted by Rams Swimming Club

University of Rhode Island Tootell, Kingstown, RI

February 22-25, 2007

Sanctioned by NE Swimming #NE-06-00(TT)

CONTACT INFORMATION

Team Name: ______________________________________________ Abbreviation: _______________

Deck Coach: ______________________       Phone: ________________ Email: _____________________

Entries Contact: ______________________   Phone: ________________ Email: _____________________

ENTRY FEES

____               10 & Under Individual Events @ $3.50 / $4.00 =                        $______

   ____              10 & Under Individual (400M or longer) @ $5.00 / $5.50 =      $ ______

    ____                10 & Under Relays @ $14.00 / $14.50 =                                 $ _______

    ____                11-12 Individual Events @ $5.00 / $5.50 =                              $ _______

    ____                11-12 Individual (400M or longer) @ $5.00 / $5.50 =              $ _______

    ____                11-12 Relays @ $20.00 / $20.50 =                                          $ _______

    ____                Per-Swimmer NE Travel Fee Surcharge @ $2.00/swimmer =   $ _______

    ____                Swimmer Participation Fee @ $5.00/swimmer =                       $ _______

                Total:    $ _______

Make one check payable to: The Rams Swimming Club

Mail entries and check to: Mike Dignan, 10 Dogwood Lane, Mystic CT 06355

Entry Deadline: emailed by February 19, 2007- Payment, waiver and hard copy, by February 21, 2007

NE 12 & Under Championships Entries For e-mailed entries, this form and payment

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, Rams Swimming Club, and The University of Rhode Island for any

and all injuries suffered by him/her at said meet. In submitting this entry the undersigned team certifies

that all athletes in the entry are registered with USA Swimming and understands that the team may be

fined $100 for each swimmer in the entry that is not registered with USA Swimming.

____________________________________                                                                __________

Signature of Authorized Team Official                                                                   Date