Linrand Masters Swimming Club

WAHOO MASTERS SWIMMING CLUB FROSTBITE SERIES 2005 – GALA NO 2 – ENTRY FORM

Wahoo Aquatics Centre, St Peters College, Maxwell Dr, Sunninghill SATURDAY 11TH JUNE 2005 – Registration 17h45 to 18h30 – Start 19h00. MEN WOMEN EVENT ESTIMATED EVENT ESTIMATED EVENT NO TIME TIME NO 1 25m BACKSTROKE 2

3 100m BREASTSTROKE 4

5 50m BUTTERFLY 6

7 25m FREESTYLE 8

9 200m FREESTYLE 10

11 50m BACKSTROKE 12

13 25m BREASTSTROKE 14

15 100M BUTTERFLY 16

17 50M FREESTYLE 18

19 4 x 25m Mixed Medley Relay 20

NB: Please circle the event number of each event entered. Submit for each event a recent or reasonable time, failing which you will be seeded last. Please also call for 3(three) timekeepers, when you swim, if you are attempting to break a record. No record attempts for 25m will be allowed. You may swim a maximum of 4 (FOUR) individual events. The ‘No False Start’ rule will apply. Pre-entries are R20.00 and can be faxed to 888-1411, by no later Friday 10 June (paid on 11 June at pool). Late entries on the 11 June 2005 are R30.00.

I agree that I participate at my own risk and that, by signing this form, I waive against the Wahoo Masters Swimming Club and their officers, members, servants and agents, and indemnify the same, in respect of all claims arising from or connected with any injury or loss which I might sustain while, or as a result of participating in any Masters Swimming or related activity whether caused by negligence or otherwise.

FIRST NAME………………..…………………SURNAME…………………….………………………..

CLUB…………………………………………………………….. SEX M / F.

CONTACT TEL NOS……………………..…………..…Email…………………………….………………

DATE OF BIRTH………………………………………… SIGNATURE……………………………