<p> NEW ENGLAND MASTERS SWIM CLUB Wheaton College MINI MEET Saturday, January 29, 2005</p><p>Sanctioned by: New England LMSC for USMS, Inc., Sanction # - pending Location: Wheaton College – Norton, MA</p><p>Time: 8:00am Warm-up, 9:00 am Start</p><p>Entry Fee: $5.00 entry fee and $3 per event (maximum 5 events) USMS Membership Required (may register at the meet) Deck entries will be accepted until just before the start of the meet. Make checks out to New England Masters Swim Club Meet Directors: JP Gowdy - ([email protected]) Contact JP for directions, etc. Order of events (circle the events you are entering): 1. 500 Freestyle* 6. 100 Individual Medley 11. 50 Breaststroke 2. 100 Butterfly 7. 200 Freestyle 12. 100 Freestyle 3. 50 Backstroke 8. 200 Backstroke 13. 50 Butterfly 4. 100 Breaststroke 9. 200 Breastroke 14. 100 Backstroke 5. 200 Butterfly 10. 50 Freestyle 15. 200 IM</p><p> Swimmers swimming the 500 are responsible for securing a counter.</p><p>Total Number of events entering = _____ X $3.00 = ______+ $5.00 meet entry fee = ______Total due</p><p>Name:______USMS Registration # (required): ______</p><p>Address:______Birth Date:______Phone: ______</p><p>City, State, Zip:______</p><p>Age:______Gender: Male ____ Female ____</p><p>Athlete’s Release: I the undersigned participant, intending to be legally bound, hereby certify that I am physically fit and have not been otherwise informed by a physician. I acknowledge that I am aware of all the risks inherent in Masters Swimming (training and competition), including possible permanent disability or death, and agree to assume all of those risks. AS A CONDITION OF MY PARTICIPATION IN THE MASTERS SWIMMING PROGRAM OR ANY ACTIVITIES INCIDENT THERETO, I HEREBY WAIVE ANY AND ALL RIGHTS TO CLAIMS FOR LOSS OR DAMAGES, INCLUDING ALL CLAIMS FOR LOSS OR DAMAGES CAUSED BY THE NEGLIGENCE, ACTIVE OR PASSIVE, OF THE FOLLOWING: UNITED STATES MASTERS SWIMMING, INC., THE LOCAL MASTERS SWIMMING COMMITTEES, THE CLUBS, HOST FACILITIES, MEET SPONSORS, MEET COMMITTEES, OR ANY INDIVIDUALS OFFICIATING AT THE MEETS OR SUPERVISING SUCH ACTIVITIES. In addition, I agree to abide by and be governed by the rules of USMS. </p><p>Signature: ______Date: ______</p>