HALLOWEEN B/C GRADE SPRINT GALA
SUNDAY 25th October 2009
Club Name: |
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Contact Name: |
| Name | DOB |
Age on Day |
Entry Times |
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50m Free |
50m Back |
50m Breast |
50m Fly |
4x25m I.M |
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Club Name: |
|
Contact Name: |
| Name | DOB |
Age on Day |
Entry Times |
||||
50m Free |
50m Back |
50m Breast |
50m Fly |
4x25m I.M |
|||
Club Name: |
|
Contact Name: |
|
Phone Number: |
|
Email Address: |
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Postal Address: (include postcode) |
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No. of Boys entered: |
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No. of Girls entered: |
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Total No. of Swimmers: |
No. of Girls Entries: |
x £3.75 per entry = | £ | ||
No. of Boys Entries: |
x £3.75 per entry = | £ | ||
No. of Cannon Teams (Morning): |
x £FREE = | £ 0 . 00 | ||
No. of Cannon Teams (Afternoon): |
x £FREE = | £ 0 . 00 | ||
No. of Coaches Passes Required: |
x £12.00 per pass = | £ | ||
Total Fees Due: |
£ | |||
| Tick | ||||
Fees are submitted by
(See note below): |
Enclosed Cheque: | |||
| BACS/On-line Bank Payment: | ||||
| Fees may be submitted directly to our bank account: Sort Code: 309268 Account No: 02025137. Please use 'HM09' plus your club name as the payment reference, e.g 'HM09 Wotton Widdlers'. Cheques should be made payable to: 'South Axholme Sharks' and should not be post dated. Please write 'HM09' on the reverse of the cheque. If cheques are not from a club bank account then please also write the name of your club on the reverse of the cheque. Any refunds due to rejections will be refunded by Cheque. |
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 Tick if you would like to be kept informed of future Sharks open meets |
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| Tick if your club is able to provide officials at this event |
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Completed entry forms and payments should be sent to: Julia Crow, 6 Brewery Gardens, Crowle, DN17 4LU |
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