To be completed in BLOCK CAPITALS
	Sex			___________________________________
	Surname			___________________________________
	First Name		___________________________________
	Address			___________________________________
				___________________________________
				___________________________________
				___________________________________
	Telephone No.		___________________________________
	Club			___________________________________
	Date of Birth		___________________________________
	Registration No.	___________________________________

I hereby declare that the above information is correct and that each competitor is
responsible for their own health and safety.
	Signature		___________________________________
	Date			___________________________________


	INDIVIDUAL EVENTS	      |	AGE   |	SUBMITTED
				      |	GROUP |	  TIME
				______|_______|____________________
	50m  FREESTYLE		______|_______|____________________
	100m FREESTYLE		______|_______|____________________
	50m  BACKSTROKE		______|_______|____________________
	50m  BREASTSTROKE	______|_______|____________________
	50m  BUTTERFLY		______|_______|____________________
	100m INDIVIDUAL MEDLEY	______|_______|____________________

	TEAM EVENTS					
				___________________________________
	200m MEDLEY RELAY	______|_______|____________________
	200m FREESTYLE RELAY	______|_______|____________________

				    AGE GROUPS						

		INDIVIDUAL EVENTS				RELAY's
	S - 19 - 24 yrs		F - 50 - 54 yrs		W- 100 - 149 yrs Total	
	A - 25 - 29 yrs		G - 55 - 59 yrs		X- 150 yrs and over	
	B - 30 - 34 yrs		H - 60 - 64 yrs			
	C - 35 - 39 yrs		I - 65 - 69 yrs			
	D - 40 - 44 yrs		J - 70 - 74 yrs			
	E - 45 - 49 yrs		K - 75 yrs +