1. No category

EAST REGION
2015 OPEN WATER CHAMPIONSHIP
and AGE GROUP COMPETITIONS
incorporating County Championships as appropriate
(Under ASA Laws & ASA Technical Rules)
Whitlingham Outdoor Education Centre, Whitlingham Lane, Trowse, Norwich. NR14 8TR
SUNDAY 19thJULY 2015
CLUB DATA CAPTURE FORM
The closing date for the entriesis 20thJune 2015. We require your form by
to enable us to process the entry in time.
SURNAME
FORENAMES
ASA REGISTRATION NO
DATE OF BIRTH
SEX (M/F)
LATEX ALLERGY
Y/N
DESCRIPTION OF EVENTS
EVENT 1
COST
3k Freestyle (Incorporates Nationals Qualifier ages15&16)
Region Age Groups: 13-16 17-19 20-24 25-29 30-34 35-39 40-49 50-59 60+
NOVICE 800m Freestyle – (Swum this event before? See condition 23)
EVENT 2
EVENT 3
Age Groups: 11-12 13-14 15-16 17+
1.5k Freestyle (Incorporates Nationals Qualifier ages 12,13 & 14)
Region Age Groups: 12-16 17-19 20-24 25-29 30-34 35-39 40-49 50-59 60+
PLEASE TICK
£20
£12
£20
5k Freestyle OPEN CHAMPIONSHIP & AGE GROUP
EVENT 4
(Incorporates Nationals Qualifier ages17/18 &19 & over)
Region Age Groups: 13-16 17-19 20-24 25-29 30-34 35-39 40-49 50-59 60+
No: Events entered at £12 per event
£20
No: Events entered at £20 per event
Total payment due £
Submit completed forms with correct money to your club. Cheques should be payable to your club
as they will make a bulk payment for all their entries.
Please enter me into the ASA East Region Open Water Championships and inform the organisers that I have a latex allergy
if I answered Y above.
I declare that I am an eligible competitor as defined by A.S.A. law.
I have read the document headed East Region Championships2015 Open Water SwimmingConditions, understand the
conditions and agree to abide by them.
Signature of Competitor ....................................................................... Date ..................................................
Signed ___________________________________________________
Parent/Guardian (Swimmer under 18)