Licence 3ER170554 Level 3
Teamipswich Swimming
(Affiliated to SCASA and ASA East Region)
July Surprize Open2017
(Under ASA Laws and ASA Technical Rules)
At Crown Pools, Ipswich, 9th July 2017
License number 3ER170554 Level 3
ENTRIES SUMMARY FORM
ONE OF THESE FORMS MUST ACCOMPANY CLUB ENTRIES, OR ANY INDIVIDUAL ENTRY FORM(S)
CLUB:......
CONTACT NAME:......
ADDRESS:......
......
EMAIL:......
POST CODE:......
TELEPHONE:......
NUMBER OF ENTRIES @ £3.50:...... =£......
NUMBER OF COACHES PASSES @ £10.00 each:...... =£......
TOTAL REMITTANCE:=£......
Bank details: TeamIpswich Swimming, Sort Code 08-92-99, Account 65758384, Reference JULY17 “CLUB CODE / SWIMMER NAME”. Please attach printed BACS confirmation to this form.
ONE BACS PAYMENT PER CLUB ENTRY PLEASE
NUMBER OF ATTACHED INDIVIDUAL ENTRY FORMS:......
CLOSING DATE FOR ENTRIES IS MONDAY 19th JUNE 2017
All Entries Summary Forms with their Individual Entry Forms, accompanied by the full entry fees to be sent to
ENTRY IS INITIALLYFIRST COME FIRST SERVED. HOWEVER TO COMPLY WITH LICENSED MEET TIMINGS WE MAY STILL HAVE TO REDUCE ENTRIES TO INDIVIDUAL EVENTS.
Teamipswich Swimming
(Affiliated to SCASA and ASA East Region)
July Surprize Open2017
(Under ASA Laws and ASA Technical Rules)
At Crown Pools, Ipswich – 9th July 2017
License number 3ER170554 Level 3
INDIVIDUAL ENTRY FORM
FOR INTERNAL CLUB USE or PAPER ENTRIES
FORENAME ...... SURNAME...... D.O.B...... /...... /......
CLUB...... MALE/FEMALE………...... Age on D.O.M....…
FULL ADDRESS......
...... TEL.No......
A.S.A. REGISTRATION No.
ENTRY IS INITIALLY FIRST COME FIRST SERVED BY CLUB. HOWEVER TO COMPLY WITH LICENSED MEET TIMINGS WE MAY STILL HAVE TO REDUCE ENTRIES TO INDIVIDUAL EVENTS.
EVENT / ENTRY TIME / RestrictionsTimes entered should be 25m or 50m converted times.
50m FREESTYLE
100m FREESTYLE
50m BACKSTROKE
100m BACKSTROKE
50m BREASTSTROKE
100m BREASTSTROKE
50m BUTTERFLY
100m BUTTERFLY
100m I. M.
Entry Fee (£3.50 / event) / £
Admin Fee (Late Entry only) / £5.00
Total Entry Fee / £
ENTRY FEE IS £3.50 PER EVENT. An administration fee of £5.00 will be charged per swimmer for entries received after the closing date. One payment per Club Entry please.
Please Note: Photographs may be taken at this meet and used for publicity purposes in accordance with ASA regulations concerning the use of video close range or zoom photography. If swimmers or parents/guardians of competitors under the age of 18 do not wish such photographs to be published, they should notify the meet organiser in writing by attaching a letter to this form.
CLOSING DATE FOR ENTRIES IS MONDAY19th June 2017
Teamipswich Swimming
July Surprize Open 2017
REQUEST FOR OFFICIALS
If you are able to assist with any officiating we would kindly appreciate your help. We feel galas are best officiated by officials from a variety of clubs to create the most fair atmosphere.
We will aim to make your day of officiating as pleasant as possible!
If you are able to assist please contact:
Louise Perkins