Eastern Zone Super Sectional
Long Course Speedo Championship Series Meet
Team Summary Sheet

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

          Mail, postal express, or federal express this form with your entries and fees with
SIGNATURE WAIVER to:

Linda Davis
41045 Paw Paw Hollow Ln
Leonardtown, MD 20650

301-475-2540
davisfamily@gmpexpress.net

Make checks payable to "Chesapeake Bay Aquatic Club"

          Club Name:       __________________________________________

          Club Code:        _________________

          LSC:                   _________________

          Coach:               _________________         

          Phone:               ____________        

         Cell Phone:         ____________       

          Email Address: ____________________

          Address:            __________________________________________

          City:                    _____________      State: ______       Zip: ____________

          Total Individual Entries: ________    x    $10.00 =    _________

          Total Relay Entries:       ________    x    $25.00 =    _________

          Total Amount Due:                                                        _________