APPLICATION DEADLINE TUESDAY JULY 19, 2005 at 4PM
PVS 2005 LONG COURSE ZONE TEAM APPLICATION
FOR USE BY 14/UNDER SWIMMERS ONLY

NAME AGE 
(As of August 10, 2005)
 
ADDRESS SEX: M   F 
  CLUB  
PHONE #(________)
E-MAIL ADDRESS 
Athletes USA Swimming Registration #  
NOTE: Application will not be accpeted without correct USA swimming registration number.
COACH   COACHíS PHONE # #(________)

SELECTION OF RELAYS Relay teams will be selected by the Zone Team coaching staff. The position in a relay and/or the strokes swum in medleys will also be determined solely by the coaching staff.

We have reviewed the Information Sheet. In submitting this application, we understand that a swimmer selected for this team will be representing PVS, and as such will follow all guidelines and codes of conduct established by Potomac Valley Swimming.

VERY IMPORTANT: We further acknowledge that we are aware that PVS will travel to and from Zones as a team this year. This means we undetstand we must travel to the meet with the team -- leaving Tuesday mornng August 9 and returning Sunday afternoon -- August 14. We will stay at the team hotel, have meals with the team, and participate in other team activities unless officially excused by the Head Coach or Team Manager.

Swimmerís Signature:   Date:  
Parentís
Signature:
 
Mail completed zone application to: Mark Faherty   9730 Blake Lane ;   Fairfax, VA 22031    Applications may be FAXed to 703-924-5414
IMPORTANT:: Deadline for all applications is TUESDAY JULY 19, 2005 at 4PM Note: If using Fed Express, UPS, etc., sign the waiver allowing for the service to leave your application without requiring a signature. Total fees are $590. Meet entry deposit of $250 must accompany application or if faxed, be received by FRIDAY, JULY 22. The remaining balance of $340 is due by August 4th.

Event # Event Seed TimeMeet/Date Acheived14/U Ch
     
     
     
     
     
     
Note: Please place an "x" in the 14/U Ch column if you are entered into this event at 14/U Championships. If you improve your entry time in one of these events, we will automaically update your entry time for you.

I am planning to swim the following events at 14/U Champs at which I hope to achieve a Zone QT for the first time.
EventEventEventEventEvent
     
I understand if I do so, I must notify the Zone table at the 14/U Champs and update the list of events in which I wish to enter.

Please check one of the following statements:

________ I have already qualified for at least one individual event and will definately particpate on PVS EZ team.
________ I only wish to participate on the team if I qualfiy for at least the following number of events ___________

Any swimmer wishing to withdraw from the team should have checked the second box above and must also contact the Zone Table at the 14/U Champs. Your deposit check will be returned to you if you notify PVS NLT July 25.

Swimmers with a Disability. Are you applying to be a member of the PVS Eastern Zone Team under provisions in the meet announcement pertaining to swimmers with a disability. (see pages 4-5)
Yes ________ No _________
If so, please also complete this additional form. You may update the specific events you want to swim until July 26.

Late applications for this meet will be accepted thru the conclusion of 10/U session Sunday July 24. They must be submitted to the zone table at the Age Group Championship Meet. A late application fee of $15 payable to PVS will be charged. The initial deposit of $250 will also be due at this time.