Chester Le Street ASC entries

gala entries

Click here to download and print Gala Entry Form

Please note: All forms must now be handed in to the gala secretary with correct payment at time of gala application. As from January 2012 we will not accept on-line entries.

Gala Entry Form

Chester-le-Street ASC

Name:

DOB:

Gala:

FREE	BRST	BACK	FLY	IM
50	50	50	50	100
100	100	100	100	200
200	200	200	200	400
400
800
1500

Parent/Guardian Name:

e-mail address:

Gala Fee amount:

Date:

……………………………………………....................................

CLS ASC Receipt – to be completed by Club official

Gala……………………………………….. Swimmer…………………

Amount Paid(cash/chq)..………..

Signed …………………………………… Dated………………………

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