POTOMAC VALLEY SWIMMING
SWIMMER WITH A DISABILITY AWARD
NOMINATION FORM FOR
2006 - 2007 CONSIDERATION

NOMINEE 
  		PVS # 
 
CLUB 
  		 
 

CRITERIA FOR CONSIDERATION:

ACHIEVEMENT/EVENT EVENT PLACE POINTS

 EXAMPLE: Qualified for Can-AM Series Meet

100 Meter Back N/A 1
 EXAMPLE: US Paralympics Spring Can-Am, Montreal

 100 Meter Free

First.05
 
 		 
 		 
  		 
 
 		 
 		 
  		 
 
 		 
 		 
  		 
 
 		 
 		 
  		 
 
 		 
 		 
  		 
 
 		 
 		 
  		 

 TOTAL POINTS 

 
SUBMITTED BY: 
 
ADDRESS 
 :
PHONE: 
  		DATE: 
 

NOMINATIONS MUST BE RECEIVED BY NOON, FRIDAY, SEPTEMBER 21, 2007 FOR CONSIDERATION.
See detailed instructions and criteria

MAIL TO: Swimmer with a Disability Award
Potomac Valley Swimming
P.O. Box 3729
McLean, VA 22103-3729
 
Email To: 2007 Outstanding Swimmer with a Disability
 
FAX TO:202-318-2505