2022 Ozark LMSC LCM Masters Meet Entry Form -

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2022 Ozark LMSC LCM Masters Meet Entry Form
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2022 Ozark LMSC LCM Masters Meet

Entry Form

Below is the entry form for the 2022 Ozark LMSC LCM Masters Meet meet held 6/4/2022 at Chuck Fruit Aquatic Center in Edwardsville, IL.

Please review the following forms:

Meet Entry Form

COVID-19 Safety Plan Addendum

One Event Registration Form & Waiver (for meet entry for non-USMS members) – OEVT Form

Name (as listed on 2022 USMS card) *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

2022 USMS Number *

Enter OEVT if you do not have a current USMS membership. NOTE: OEVT entries are not eligible for Ozark or National records or USMS or FINA Top Ten status.

OEVT Waiver Signature *

Please review the OEVT attachment at the beginning of the entry form and sign your full name and date here to indicate acceptance.

Club Affiliation

If none, please type "Unattached."

Birthdate *

Age (on December 31, 2022)

Gender (M/F) *

Phone

Email *

Emergency Contact Name *

Emergency Contact Phone *

Individual Events

1 - 100 Freestyle
2 - 200 Butterfly
3 - 50 Breaststroke
6 - 400 Freestyle
7 - 100 Breaststroke
8 - 200 Backstroke
9 - 50 Butterfly
10 - 200 Individual Medley
11 - 200 Freestyle
12 - 200 Breaststroke
13 - 50 Backstroke
14 - 100 Butterfly
16 - 400 Individual Medley
17 - 100 Backstroke
18 - 50 Freestyle
21 - 800 Freestyle
22 - 1500 Freestyle

Maximum 6 Individual Events

100 Free Seed Time *

200 Butterfly Seed Time *

50 Breaststroke Seed Time *

400 Freestyle Seed Time *

100 Breaststroke Seed Time *

200 Backstroke Seed Time *

50 Butterfly Seed Time *

200 Individual Medley Seed Time *

200 Freestyle Seed Time *

200 Breaststroke Seed Time *

50 Backstroke Seed Time *

100 Butterfly Seed Time *

400 Individual Medley Seed Time *

100 Backstroke Seed Time *

50 Freestyle Seed Time *

800 Freestyle Seed Time *

1500 Freestyle Seed Time *

Relays

4 - M, W, or Mixed 200 Free Relay
5 - M, W, or Mixed 400 Free Relay
15 - M, W, or Mixed 800 Free Relay
19 - M, W, or Mixed 200 Medley Relay
20 - M, W, or Mixed 400 Medley Relay

Please mark if you are interested in competing in relays. Meet Director will contact anyone interested to set up lineups prior to meet. No relay deck entries will be allowed.

Volunteer Interest

Volunteers

Check this box if you have friends/family able and interested to volunteer as timers or pre-meet organization.

USMS Participant Waiver and COVID Policy Electronic Signature *

Check Here for Acceptance

By entering the 2022 Ozark LMSC Long Course Meters Masters Swim Meet, I electronically sign that I have read and agree to comply with its Covid-19 Safety Plan Addendum, including that I may be prohibited from participating if I have symptoms of Covid-19 infection. I further agree that Online Entry includes Electronic Signing of the USMS Participant Waiver (r.5/26/20)

Meet Entry Fee

Meet Entry - $ 30.00

OEVT Registration Fee

Price: $ 15.00

($15.00 to USMS)

Total

$ 0.00