Deventio Excel Entry Form 9/10 April
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Swimmers Name GALA Age as at: Date of Birth: 31/12/2016 Male / Female Event Entry Time LC Achieved @ 50m Freestyle 100m Freestyle 200m Freestyle 400m Freestyle 800m Freestyle 1500m Freestyle 50m Backstroke 100m Backstroke 200m Backstroke 50m Butterfly 100m Butterfly 200m Butterfly 50m Breaststroke 100m Breaststroke 200m Breaststroke 100m IM 200m IM 400m IM Total no. of Entries 7.00 £ - £ each Coaches Pass (Contribution) 1 2.00 £ 2.00 £ If payment is not received your entry will not be submitted Payment to be made by direct bank transfer to the above account Date of payment/reference Contact email address All forms to be returned by 22/02/16 No late entries accepted Return by email to: [email protected] or Return to competition box at Accrington Academy - £ Please tick the box to certify that the above information, including entry times, are correct to the best of your knowledge. Barclays Bank Account Sort: 20-09-72 Account: 33006271 Total Gala Entry Form Deventio 10th Open 9/10 April ASA Reg. Number
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Printable entry form for Derventio Excel April Meet.NOTE: Nobody to enter 800m/1500m events at this competitionClub Closing Date 22nd February 2016
Transcript of Deventio Excel Entry Form 9/10 April
Swimmers Name GALA
Age as at: Date of Birth:31/12/2016
Male / Female Event Entry Time LC Achieved @
50m Freestyle
100m Freestyle
200m Freestyle
400m Freestyle
800m Freestyle
1500m Freestyle
50m Backstroke
100m Backstroke
200m Backstroke
50m Butterfly
100m Butterfly
200m Butterfly
50m Breaststroke
100m Breaststroke
200m Breaststroke
100m IM
200m IM
400m IM
Total no. of Entries 7.00£ -£ each
Coaches Pass (Contribution) 1 2.00£ 2.00£
If payment is not received your entry will not be submitted
Payment to be made by direct bank transfer to the above account
Date of payment/reference
Contact email address
All forms to be returned by 22/02/16 No late entries accepted
Return by email to: [email protected]
or
Return to competition box at Accrington Academy
-£
Please tick the box to certify that the above information, including entry
times, are correct to the best of your knowledge.
Barclays Bank Account
Sort: 20-09-72
Account: 33006271Total
Gala Entry Form
Deventio 10th Open 9/10 April
ASA Reg. Number
