Chester-Le-Street gala entry form

Gala Entry Form
First name:
Family name:
Date of Birth: (Competitor)		Day	Month	Year
Gala name: e.g. Derwentside Graded Gala
E-mail address:
Event Selection
FREE	BRST	BACK	FLY	IM
50	50	50	50	100
100	100	100	100	200
200	200	200	200	400
400
800
1500
Today's Date		Day	Month	Year
Parents/Guardians Name
If you have any queries regarding entries please email: andrea@chester-le-street-asc.org Closing date for applications varies. Please check the notice board and web site gala page to ensure you submit your form in time. Payment for each entry must be paid in person NO later then the gala closing date. Cheques made payable to Chester le Street ASC. Payment must be handed to Andrea Maddison in person. Andrea will be available in the club foyer on the 1st Friday of each month. Please ensure that you retain a copy of the entry for your own records.