Principles of YMCA Competitive Swimming & Diving Course

Date: March 16, 2012      Time: tentative 10:30 AM    Sanction Number  12NYAQ412BY001

Place: Erie Community College - Competition Pool -mTentative

Cost: $ 50 make check payable to NYS Swim Commission

Name _____________________________ YMCA___________________

Last 4 digits Social Security # ___________ Birthday ________________

Address Street_________________________________

City ________________________ State ______ Zip ____________

Phone ___________________ email ________________________

Participants Signature  ________________________________

 YMCA Address ____________________________

City ______________                 State  __________ Zip _________

               Phone __________________  Email _______________________

YMCA Supervisors Name ____________________

Position   _______________________________________

Signature _______________________________________

 Send to Frank Ranhofer

291 Devon Lane

West Chester Pa. 19380