Age Groups:(circle one) 19-24,
25-29,30-34,35-39,40-44,45-49,50-54,55-59,60-64,65-69,etc..
Age Group for relays: 19+,
25+,35+,45+, 55+,65+
________________________________________________________________________________
1. 200 Medley Relay M/F__________________10. 50
backstroke____________________________
2. 200 Freestyle_________________________11. 100
Butterfly____________________________
3. 200 I.M.______________________________12. 500
Freestyle__________________________
4. 50 Freestyle_________________________ 13.
200 Mixed Free Relay____________________
5. 100 Backstroke_______________________ 14. 50
Breastroke___________________________
6. 100 Breastroke _______________________ 15. 100
Freestyle__________________________
7. 2X 50 Mixed Free Relay________________
16 200 Backstroke________________________
8. 50 Butterfly__________________________ 17.
100 I.M.______________________________
9. 200 Breastroke_______________________ 18. 1650
Freestyle_________________________
( 5 event limit plus relays)
______________________________________________________________________________
Name__________________________________________________
Phone_______________
Address________________________________________________
Birth Date_____________
City,
State,Zip__________________________________________ Age_______
Gender: M/F
_______________________________________________________________________________
ATHLETE'S RELEASE; 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 the
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.
________________________________________________________________________________________________
Signature__________________________________________________date________________