Badger US Swimming Dues Form & Meet Sign up

BRONZE/SILVER/GOLD TEAMS

Please complete the Following:

USA SWIMMING 2009 ATHLETE REGISTRATION APPLICATION

LAST NAME

LEGAL FIRST NAME

MIDDLE Initial PREFERRED NAME

DATE OF BIRTH (MO./DAY/YR.) SEX (M/-F)

ADDRESS

CITY STATE

ZIP CODE Phone ( )

SIGN USA Swimming occasionally makes its membership list available to its marketing partners. Please notify USA Swimming’s Member Services Dept. at 719/866-4578 if you do not wish to receive these mailings.

HERE x_____________________________________________________________ SIGNATURE OF ATHLETE, PARENT OR GUARDIAN ANNUAL MEMBERSHIP DUES OF $41.00 OR MORE INCLUDE $2 FOR A 1-YEAR SUBSCRIPTION TO SPLASH

MAKE CHECK PAYABLE TO: Carle Fierro - EF

REGISTRATION FEE (USA Swimming Fee $45.00 + LSC Fee $10.00) = TOTAL DUE$55.00

All Bronze, Silver & Gold Must Join US Swimming regardless of whether they are doing meets or not.

US Swimming Dues: $ 55.00

All Bronze, Silver & Gold Must Join US Swimming $

MAKE CHECK PAYABLE TO: Badger AGT - Fees