Eastern Zone Super Sectional
Long Course Speedo Championship Series Meet
Relay Entry Form

July 21-24, 2005
St. Mary’s College, St. Mary’s City, MD

         Team Name:                         ____________________________________   

         Team Contact:                      ____________________________________   

         Contact Phone:                     ____________________________________   

         Contact Email:                      ____________________________________   

         Swimmer A's Name:                __________________________________________
                                                              Last                           First                           M.I.
         Swimmer A's Date of Birth:     _________________
                                                               (MM/DD/YY)
         Swimmer A's USA Number :   ____________________________________________
                                                               MMDDYYFFFMLLLL (birthday First 3 Middle 1 Last 4)

         Swimmer B's Name:                __________________________________________
                                                              Last                           First                           M.I.
         Swimmer B's Date of Birth:     _________________
                                                               (MM/DD/YY)
         Swimmer B's USA Number :   ____________________________________________
                                                               MMDDYYFFFMLLLL (birthday First 3 Middle 1 Last 4)

         Swimmer C's Name:                __________________________________________
                                                              Last                           First                           M.I.
         Swimmer C's Date of Birth:     _________________
                                                               (MM/DD/YY)
         Swimmer C's USA Number :   ____________________________________________
                                                               MMDDYYFFFMLLLL (birthday First 3 Middle 1 Last 4)

         Swimmer D's Name:                __________________________________________
                                                              Last                           First                           M.I.
         Swimmer D's Date of Birth:     _________________
                                                               (MM/DD/YY)
         Swimmer D's USA Number :   ____________________________________________
                                                               MMDDYYFFFMLLLL (birthday First 3 Middle 1 Last 4)

Relay Events: $25.00  
Relay Rules:

1. All entered relays must have bettered the event qualifying time
2. (2) relays max per team.
3. No time trials for relay only swimmers.
4. At least one swimmer participating on each relay team must also be entered and compete in at least one individual event. 

         Event Number         Event Name        Relay Time                Fee        Paid

         ___________         __________      _____________      _____     _____

         ___________         __________      _____________      _____     _____