| 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 | COACH’S 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.
| Swimmer’s Signature: | Date: | ||
|
Parent’s 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. Meet entry deposit of $250 must accompany application or if faxed, be received by FRIDAY, JULY 22. |
| Event # | Event | Seed Time | Meet/Date Acheived |
|---|---|---|---|
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)
If so,
please also complete this additional form.