A | B | C | D | E | F | G | H | I | J | K | L | M | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | |||||||||||||
2 | Birthdate M/DT/YY | ||||||||||||
3 | Standard | Silver | Gold | First name | Middle name | Last Name | Email Address | ||||||
4 | |||||||||||||
5 | 1 | ||||||||||||
6 | |||||||||||||
7 | 2 | ||||||||||||
8 | |||||||||||||
9 | 3 | ||||||||||||
10 | |||||||||||||
11 | 4 | ||||||||||||
12 | |||||||||||||
13 | 5 | ||||||||||||
14 | |||||||||||||
15 | 6 | ||||||||||||
16 | |||||||||||||
17 | # of Athletes | ||||||||||||
18 | USA Swimming Registration Fee: (Summer 2012 good through Aug. 31, 2012) | $37.50 | |||||||||||
19 | Club Dues: Payable once per year - $30 entire year - $20 summer good through Aug. 31, 2012 | $20 | |||||||||||
20 | |||||||||||||
22 | Pick 1/athlete | Pella Swim Club Gold: Includes 10 practices sessions no meet splash fees - Summer season May. 1- Aug. 31 | $115 | ||||||||||
23 | Pella Swim Club Silver: Includes 3 practice sessions & must pay meet splash fees - Summer season May. 1- Aug. 31 | $55 | |||||||||||
24 | Pella Swim Club Standard: Includes no practice sessions must pay meet splah fees - Summer season May. 1- Aug. 31 | $15 | |||||||||||
25 | |||||||||||||
26 | Late Fee if register after May 7, 2012 (if miss deadline only paid once per family not per athlete) | $20 | |||||||||||
27 | Recommended Bank amount for season $15-$50/meet based on level of club & meets planning to attend | ||||||||||||
28 | Credits or Banked deposits to be applied | Credits | |||||||||||
29 | Payable by check to Pella Swim Club | Total Due | |||||||||||
30 | check # | Amount paid 5/7 | $0.00 | ||||||||||
31 | Balance due 6/11 | ||||||||||||
32 | |||||||||||||
34 | Date Registered & paid: | Yes | I give permission for photographs of my child/children taken during club events to be posted on the Pella Swim Club Website. | ||||||||||
35 | Reg. due May 7, 2012 | No |