Riptide Masters Registration

2011-2012

(to print, right-click this page and select print)

Please make checks payable to:

Riptide Swim Team

Please circle the practice days/times you'd like to attend:

Tuesday: 12:00pm-1:00pm

Monday: 8:30pm-9:30pm

Mail registration form and payment to:

Shandra Richardson

6712 Jackpin Place

Gainesville, VA 20155

SWIMMER(S) NAME

LAST NAME

FIRST NAME

STREET

CITY

STATE

ZIP

HOME PHONE

E-MAIL ADDRESS

EMERGENCY CONTACT

EMERGENCY PHONE

Payment: Cub Run 1 x a week = $335.00, Freedom Center 1 x a week = $285.00

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