Revised November, 2015

MSI RECOGNITION JACKET & PATCH ORDER FORM

National Age Group Top-10 Ranked & National Championship Qualifiers

Minnesota Swimmers achieving one of these recognitions for the first time are eligible to receive a jacket for a minimal charge. Swimmers who have already received a jacket may order another patch in each subsequent year that they qualify, which they may place on their jacket. To receive a jacket, swimmers must be ranked T-10 in the nation as published from the final USA Swimming list published in Swimming World. “National Qualifier”, athletes must have achieved a senior national qualifying time and must have attended the respective meet. Athletes may order a replacement jacket at full cost only if their name is on the MSI list for having previously received a jacket.

Swimmer’s Name: ______

“Name” as you wish embroidered on jacket: ______

Address: Street ______

City ______State______Zip______

Phone: ______Club Abbreviation: ______

Please check one: ______First Time Jacket or ______Replacement Jacket

______Top-10 Recognition or ______National Qualifier

Subsequent year

recognition patch ______Top-10 or ______National Qualifier Patch

Top 10 – Event ______Age Group ______

National Qualifier – Meet Attended ______

Jacket Description: The recognition jacket is a light weight, lined, pullover with 1/2 front zipper. The jacket is green on the bottom & white on the top. “Minnesota Swimming” is printed on the back. Name will be embroidered on the right front.

Jackets will be distributed in the following manner: (Please indicate your choice below)

______Pick up at the MSI office (Please call ahead).

______Mail to the name & address indicated above.

Minnesota Swimming will pay the majority of the cost for a “first time” jacket. Swimmers pay $20.00 (XL & XXL extra). Replacement jackets will be available for $50.00 (XL & XXL extra). Checks payable to Minnesota Swimming must accompany this order form. Mail to MN Swimming, 1001 Hwy #7, Suite 250, Hopkins, MN 55305. No jackets or patches will be given unless ordered.

The order deadline is March 1, 2016.

Indicate Size: First Time Jacket: $ 20.00 $______

_____ Small (36-38) Replacement Jacket: $ 50.00 $______

_____ Medium (40-42) X-Large (add $3.00): $ 3.00 $______

_____ Large (44-46) XX-L (add $5.00): $ 5.00 $______

_____ X-Large (48) If order is to be mailed: Shipping & Handling: $ 7.00 $______

_____ XX-Large (50)

Total Enclosed: $______

______Subsequent year patch only (No charge)

OFFICE USE ONLY

Date Order Received: ______Paid $ ______Check # ______

Date Picked Up ______Date Mailed ______