ENTRY FORM

OTTERS CLUB CARTER ROAD, BANDRA (W), MUMBAI - 400 050. OTTERS CLUB 32ND OPEN SWIMMING & DIVING CHAMPIONSHIP 2017

ENTRY FORM Name of Unit (School / Institution) __________________________________________Date: ________2017

Sr. No.

Name of Competitor

Male/ Female

Date of Birth

Age Group

Event Nos.

Total No. of Events

Entry Fees (Rs.)

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Total entry fees: Rs. ________________ Phone no. of coach / official: ______________________________

STAMP OF THE CLUB/INSTITUTION

NAME & TEL NO. OF THE OFFICIAL IN-CHARGE

SIGNATURE SECRETARY/MANAGER

OTTERS CLUB 32ND OPEN SWIMMING & DIVING CHAMPIONSHIP 2017

ENTRY FORM FOR RELAYS ONLY EVENT No._____________

S. No.

ENTRY FEES Rs._____________

NAME OF THE COMPETITOR

DATE OF BIRTH

FIRST NAME – SURNAME (BLOCK LETTERS) 1 2 3 4 5 6 EVENT No._____________

S. No.

ENTRY FEES Rs.____________

NAME OF THE COMPETITOR

DATE OF BIRTH

FIRST NAME – SURNAME (BLOCK LETTERS) 1 2 3 4 5 6 EVENT No._____________

S. No.

ENTRY FEES Rs._____________

NAME OF THE COMPETITOR

DATE OF BIRTH

FIRST NAME – SURNAME (BLOCK LETTERS) 1 2 3 4 5 6 EVENT No._____________

S. No.

ENTRY FEES Rs._____________

NAME OF THE COMPETITOR

DATE OF BIRTH

FIRST NAME – SURNAME (BLOCK LETTERS) 1 2 3 4 5 6 TOTAL AMOUNT Rs.__________________

STAMP OF THE CLUB/INSTITUTION

NAME & TEL NO. OF THE OFFICIAL IN-CHARGE

SIGNATURE SECRETARY/MANAGER