EVENTS BOYS / MEN

AGE GROUP

TIME

FEE

3 lengths    Breastroke

3 lengths   Butterfly

City of Nottingham

Lord Henry Bentinck Cup

N/A

110 yds Freestyle

1 length Dash

N/A

EVENTS GIRLS / LADIES

AGE GROUP

TIME

FEE

3 lengths    Freestyle

3 lengths   Backstroke

City of Nottingham

Knibb Cup

N/A

110 yds Freestyle

Total

NAME__________________________________

DATE OF BIRTH_________________________ MEMBERSHIP No._______

I confirm that I am still an Amateur as defined by ASA.Law and I understand that my entry will not be

accepted if my membership is void

Please return this form to Nicky Doran, Jennie Oliver, or Sue Birchmore

along with the appropriate fee