Meet information - USA Swimming

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TEAM NAME: 2013 USA SWIMMING/SPEEDO CHAMPIONS SERIES WESTERN REGION SECTION CHAMPIONSHIP Hosted by Mt Hood Aquatics Mt. Hood Aquatic Center July 16-20, 2013 E-MAIL ENTRY FORM CLUB CODE: COACH NAME:_ PHONE #: COACH’S USA ID#: HOME ADDRESS: EMAIL ADDRESS: City State Zip E-MAIL QUALIFICATION PERIOD – July 9 - July 14, 2013 E-MAIL DEADLINE – 11:59 p.m., Sunday, July 14, 2013 (PDT) LATE ENTRY DEADLINE – 12:00 noon, Monday July 15, 2013 (PDT) NEW QUALIFYING SWIMS: Swims achieving the qualifying time standards for the first time from Tuesday, July 9, 2013 through Sunday, July 14, 2013. These e-mail entries must be received no later than 11:59 p.m. (PDT) on Sunday July 14, 2013, and may not be used to improve the seed time of a previously submitted entry. LATE ENTRIES: Swims achieving the qualifying time standards that were not entered previous to the OME deadline and will be charged twiee the entry fees. These e-mail entries must be received no later than 12:00 noon (PDT) on Monday, July 15, 2013, and may not be used to improve the seed time of a previously submitted entry. We have entered the following events on this e-mail entry form: NEW QUALIFIERS LATE ENTRIES: Women: Individual Events __________ x $8.00 = _____________ Women: Individual Events _________ x $16.00 = __________ Men: Individual Events _____________x $8.00 = _____________ Men: Individual Events ____________x $16.00 = ___________ Relays: # of Relays ________________x $20.00=_____________ Relays: # of Relays _______________x $40.00=____________ Surcharge: # of Swimmers __________x $35.00 = ____________ Surcharge: # of Swimmers _________x $35.00 = ___________ Total Entry Fee: $ __________________ Total Entry Fee: $_________________ Emailed entries must be paid at the Clerk of Course. The undersigned coach or team representative of all swimmers listed on this entry form hereby certifies that all times stated on this entry form are true and correct. Coaches Signature:_______________________________________________________________________________ Swimmer Information Print Name ______________________________________________________________ Age __________________ Team Name____________________________________________________________________________________ Female __________ Male __________ Registration # __________________________________________________ Swimmer previously entered in meet? Yes ____________ No ______________ Event # _________ Event _______________________ Time ____________________ Date Achieved ____________ Event # _________ Event _______________________ Time ____________________ Date Achieved ____________ Event # _________ Event _______________________ Time ____________________ Date Achieved ____________ Event # _________ Event _______________________ Time ____________________ Date Achieved ____________ Event # _________ Event _______________________ Time ____________________ Date Achieved ____________ If 6 th event must be dropped, please drop Event #_______________ (Duplicate this form as Necessary) Page 14 of 18
2013 WESTERN REGION SUMMER SECTION CHAMPIONSHIPS Mt. Hood Community College, Gresham, OR Application to Officiate Applicant must be a member of USA Swimming and an LSC certified official. (PLEASE TYPE OR PRINT CLEARLY) Name: __________________________________________________________ LSC: __________________________ Address: ________________________________________________________ Cell Phone: _____________________ City, State, Zip: __________________________________________________ E-mail Address: __________________________________________________ Current LSC Certifications: ________________________________________________________________________________ Current N2 Certifications and Expiration: _____________________________________________________________________ Current N3 Certifications and Expiration: ______________________________________________________________________ Years/Months at Highest Level ______________________________________________________________________________ Background Check Expiration Date: _____________________ Athlete Protection Expiration Date: ______________________ The attire for the meet is white polo shirts over khaki pants/shorts/skirts (long pants or skirts for Finals), white socks and shoes. ALL APPLICANTS MUST ATTEND MANDATORY OFFICIALS BRIEFINGS BEFORE EACH SESSION WHICH BEGIN ONE HOUR PRIOR TO THE START OF EACH SESSION I will serve at all sessions: Yes ___ No ___ I can't serve all sessions. My officiating commitments for individual sessions are checked below: Tuesday 7/16 Finals _________ Wednesday 7/17 Prelims ________ Finals _________ Thursday 7/18 Prelims ________ Finals _________ Friday 7/19 Prelims ________ Finals _________ Saturday 7/20 Prelims ________ Finals _________ Shirt Size: __________ (S, M, L, XL, etc.) APPLICATION FOR ASSIGNED POSITION: If you would like to be considered for an Assigned Position, please check the appropriate box below. If applying for more than one position, please indicate preference-1,2,3 Assignment request: ___ Deck Referee ___ Starter ___ Chief Judge ___ Admin. Ref ** If you are not applying for an Assigned Position, please check here: ___ Stroke & Turn Only APPLICATION FOR EVALUATION: If you would like to be evaluated during the meet, complete the following: I request Evaluation as follows: ___ For Advancement to N2 ___ For Advancement to N3 ___ For Recertification ___ For Education ___ Referee ___ Starter ___ Chief Judge ___ Admin Ref ___ Stroke & Turn Most Recent Evaluation & Evaluator _________________________________________________________________________ ------------------------------------------------------------------------------------------------------------------------------------------ This application must be received by the Meet Referee no later than June 7, 2013 in order for the applicant to be considered for specific assigned positions (Deck Referee, Starter, Chief Judge, Admin Ref). Assigned positions will be notified by June 14, 2013. Applications for other deck positions will be accepted anytime. However, only those applying by June 21 st will be assured of getting a meet shirt. PLEASE SEND YOUR APPLICATION TO: LINDA EATON MAILING ADDRESS: 6971 SOUTH YAMPA COURT, FOXFIELD, CO 80016 FAX: 303-699-9337 E-MAIL ADDRESS: LINDA_EATON@EMAIL.MSN.COM Page 15 of 18
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Meet information - USA Swimming

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