Worksop Dolphins Spring Open Meet 2017
License Level 3 - 3EM170503

Club: MALE / FEMALE
Given Name:
Family Name:
DOB : :
ASA Reg No:

Please Note that as far as possible entry times will be automatically taken from Ranking(since 1/1/2016) Tick the event and only enter a time if you do not have a ranked time for that particular event.

STROKE / Tick or enter time
50m Freestyle / : :
100m Freestyle / : :
200m Freestyle / : :
400m Freestyle / : :
100m Backstroke / : :
200m Backstroke / : :
100m Breaststroke / : :
200m Breaststroke / : :
100m Butterfly / : :
200m Butterfly / : :
200m Ind Medley / : :

Phone...... Email......

Number of entries...... @£5 =......

Add paper entry surcharge £1 Total ...... enclosed.

If you are entering more than one swimmer please also complete the summary form

Mrs Tracy Smeeton, 4 Wavell Close, Worksop, Notts S81 7RL

Cheques payable to ‘Worksop Dolphins SC’

(to pay by BACS please email for the account details)

CLOSING DATE – SUNDAY 26th FEBRUARYor when full, first come first served

If you are a qualified official and would like to helpplease complete the
volunteer officials form and return with your entries

Club or SS Entry Manager Summary Form
Please complete this summary form and return it with payment to the gala administrator.
(Entry acknowledgment is via the website)

CLUB …………………………………………………………….. Date …………………………

Entry Coordinator………………………………………………. Tel No …………………………

EMAIL ……………………………………………………………………………………………………..

Swimmer’s Name(Individual events £5.00)
/
Number of Events
/
Fees Total
Total swims @ £5
Coaches passes @10
For paper entry forms add the surcharge of £1 per swimmer / No of swimmers
...... @ £1 =
/ Total Enclosed =
If using SS Entry Manager, pleasecomplete this form only and return with paymentIndividualentry forms are not required.
DO NOT FORGET TO APPLY FOR YOUR COACHES’ PASS

Cheques payable to ‘Worksop Dolphins SC’

(To pay by BACS please email for the account details)

COACHES POOLSIDEPASS

APPLICATION FORM

CLUB
NAME
ASA NUMBER
DBS NUMBER
NAME
ASA NUMBER
DBS NUMBER
NAME
ASA NUMBER
DBS NUMBER

Poolside passes will only be issued to ASA registered coaches and team managers and must be applied for in advance. Poolside space is limited so passes will restricted depending on the number of swimmers entered for your club. Passes may be shared provided the names have been submitted and only one person per pass is on the poolside at any one time.

Include the payment of £10 with your entries

Please collect passes on the day from our door stewards.

Cheques payable to ‘Worksop Dolphins SC’

(To pay by BACS please email for the account details)

VOLUNTEER OFFICIALS

This is a level 3 licensed meet so the requirement is for officials to be qualified, it is currently not necessary to be licensed except for the Referee.

Benefits:

Free admission and programme/start sheets

Refreshments and buffet lunch.

Travel allowance of 40p per mile,

(reduced by half to 20p if accompanying a swimmer)

Ring side view of the action.

Complimentary bottle of wine, if you last the day.

Lose weight without the expense of a sauna. 

Name:......

ASA No:......

Please tick:

Qualified as:...... J1...... J2/S...... Referee

Licensed:...... Y...... N

WE DO NEED AND APPRECIATE YOUR HELP

THANK YOU

Email: