Florida Open Water Championship Series

2010 Entry

Instructions: Type it ~ Print it ~ Mail it

PERSONAL INFORMATION

Open Water Events Distance Results posted on-line at
Last name www.
First name www.
Street address www.
City www.
State & Zip www.
Phone

ENTRY FEE: $10

Mail this completed form with a check for $10, payable to DICK BREWER, to

Dick Brewer
Florida Open Water Championship Series
2871 4th Street NE
Naples, FL 34120-1336

Entry deadline: received by Monday, December 21, 2009

Entry requirements: Your entry must include this form with a copy of your 2010 USMS registration card attached, and a check or money order for $10. Entries must be received by the above deadline.

Entry fee includes T-shirt, postage, and award if applicable. Please be sure the mailing address above is complete and correct; that is where everything will be sent.

Email
2010 USMS #
Age Sex
T-shirt size: S M L XL XXL