E N T R Y     F O R M

SOUTH   SAN   FRANCISCO   AQUATIC   CLUB   (SSFAC . NET)
    July 24-25, 2004

 
NAME: LAST                     FIRST               INTL        Print   
                          

LSC Code and year of registration(PC0,SN0,CC0)


CLUB ABBR       CLUB(UNATT)    CLUB  NAME
             

AGE         DOB mm / dd / yyyy            AMT. PAID
                   . 

USA REG NUMBER  *      HOME 

SEX   BOY   GIRL      AGE  GROUP                 
                 
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EVENT #         DISTANCE / STROKE      ENTRY TIME (min:sec:Msec)
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1.     |   /    | :  :  
2.     |   /    | :  :  
3.     |   /    | :  :  
4.     |   /    | :  :  
5.     |   /    | :  :  
6.     |   /    | :  :  
7.     |   /    | :  :  
8.     |   /    | :  :  
9.     |   /    | :  :  
10.    |   /    | :  :  
        # of Entries :   X  $ 2.25  =  $ 
                   Participation Fee:    $ 5.00
                                  Total :  $ 
  COACH(Last,First Name): , 
SWIMMERS Address L1 
     Address L2 :
PHONE # : ()  -   E-mail: