Application for Zoggs AUSSI Million Metre Award

MILLION METRES APPLICATION FORM

Please complete the details below, and forward to the National Office. Please note: For information regarding sizes see back of form.

Branch

Name of Swimmer (please print)

Swimmer’s Club (please print) and Club Code

Please circle the relevant award: 1 mil 2 mil 3 mil 5 mil 7 mil 10 mil +5 mil intervals

Please circle your colour selection for either the 1mil 2mil or 5mil metre awards:

Grey with Black trim Red with Navy trim

Size of Polo Shirt (1mil/2mil/5mil metre): Bottle with Gold trim Red with White trim (Please circle) Bottle with White trim Maroon with White trim Mens Royal with Gold trim Royal with White trim S M L XL 2XL 3XL White with Navy trim White with Red trim

Womens Navy with Red trim Navy with Gold trim Navy with Green trim Navy with White trim 8 10 12 14 16 18 20 22 24 Black with Orange trim Black with Red trim

Black with White trim Black with Gold trim

Orange with Black trim Light Blue with Navy trim

Size of Polar Fleece Jumper- (3 mil metre) S M L XL 2XL (Red)

Size of Polar Fleece Vest (7 mil metre) XS S M L XL 2XL 3XL (Red) LADIES 6 8 10 12 14 16 18 Size of Jacket (10 mil metre) (Black) MENS 12/ 14/ 16/ 18/ 20/ 22/ 24/ 26/ 28/ 30/ XS S M L XL 2XL 3XL 4XL 5XL 6XL I wish to have my own name embroidered on my top Yes No

Name to be embroidered (please print) ______

I wish to have my club name embroidered on my top Yes No I confirm that the above named swimmer has complied with all requirements to be eligible for the Vorgee Million Metre Award.

Signed State Secretary/Administrator

Please return this form to: Masters Swimming Australia Level 2, Sports House, 375 Albert Road, Albert Park 3206 Email: [email protected] Fax: (03) 9682 5444

February 2013 MILLION METRES APPLICATION FORM

VORGEE Million Metre Award INFORMATION TO ASSIST WITH SIZE SELECTION Measurements are approximate and for guidance only

POLO SHIRT (1mil 2mil or 5mil Metre Award)

To Fit S M L XL 2XL 3XL 4XL CHEST 53.5 56 58.5 61 63.5 66 70 LENGTH 71.5 74 76.5 79 81.5 84 83

Chest measurements (extend from underarm to underarm across the chest) Length measurements (shoulder to base of garment)

POLAR FLEECE JUMPER- Red (3mil Metre Award)

To Fit S M L XL 2XL 3XL CHEST 60 62.5 65 67.5 70 N/A C.B. LENGTH 70 72 74 76 78 N/A

POLAR FLEECE VEST- Red (7mil Metre Award)

To Fit XS S M L XL 2XL 3XL CHEST 53 56 59 61 64 66 69

JACKET- Black (10mil Metre Award)

Ladies Sizes To Fit 6 8 10 12 14 16 18 BUST 77 82 87 92 97 102 107 WAIST 56 61 66 71 76 81 88

Mens Sizes To Fit 12/ 14/ 16/ 18/ 20/ 22/ 24/ 26/ 28/ 30/ XS S M L XL 2XL 3XL 4XL 5XL 6XL CHEST 85 90 95 100 105 110 115 120 125 130 WAIST 77 82 87 92 97 102 107 112 117 122

February 2013