<p> CENTRAL ZONE Multi-cultural Swim Meet June 12-14, 2015 Brownsburg, IN Athlete Application</p><p>APPLICATION DEADLINE: MAY 15, 2015 RETURN APPLICATION TO: Betty Kooy, Midwestern Swimming, 1429 N Webster Ave, Hastings NE 68901</p><p>Athlete’s Name: ______</p><p>Street Address: ______</p><p>City/State/Zip: ______</p><p>Phone: ( ) ______</p><p>Athlete’s Email Address: ______</p><p>USA Swimming Number: ______</p><p>Date of Birth: ____/ ____/ ______Male ___ Female </p><p>Club Name: ______</p><p>Parent Names: (Father) ______</p><p>(Mother) ______</p><p>Parent contact Email Address: ______</p><p>Central Zone Multi-cultural Meet Opportunity: Any swimmer who represents an ethnically under-represented population that is less than 20% of the current USA Swimming membership OR current Out-Reach athletes - You may check more than one:</p><p>__ African American __ Native American __ Hispanic __ Asian or Pacific Islander </p><p>__ Out-Reach Athlete __ Other (describe) ______</p><p>Have you participated in past MWS Supported meet/s? (All-Star, Sectional, Zone or Jr. Nationals)? ______(Yes/No) If Yes to MWS supported meets, please list the meets and year/s ______(Note: Priority will be given to athletes who have not had the past opportunity to participate in MWS supported meets.)</p><p>Signatures below testify to the eligibility of the athlete:</p><p>Parent/Guardian Signature: ______</p><p>Coach of record Signature: ______MUST READ AND CHECK ALL OR APPLICATION WILL NOT BE CONSIDERED</p><p>__ I understand that I must meet the ethnicity or out-reach athlete eligibility (above) to apply for this meet.</p><p>__ I understand the additional meet details will be provided to me upon my acceptance.</p><p>__ I understand that additional paperwork that I receive MUST be returned to the Midwestern Swimming Multi-</p><p> cultural Meet Committee on or before their published deadlines. (Midwestern Office)</p><p>__ I understand funding for this meet will come from Midwestern Swimming for transportation, room and entry fees </p><p> provided for me at the meet.</p><p>__ I understand that I will be responsible for the cost of food traveling to and from the meet and while at the meet.</p><p>__ I am returning this application to Betty Kooy, Midwestern Swimming for submission by their published deadline of </p><p>May 15, 2013.</p><p>______(ATHLETE’S SIGNATURE) (DATE)</p><p>______(COACH’S SIGNATURE) (DATE)</p>