District 6 Swimming and Diving Entry Fees Form

School Name _____________________________________________________

Number of Athletes Competing ________

                 x $7/athlete                      x$7

Total Amount Paid                     ________

Note:  Minimum of $25/school.

Coach’s Name ___________________________________________________

Coach’s Contact Phone Number _____________________________________

Checks should be made payable to “PIAA District VI” and mailed by Feb. 23, 2013 to:

            Susan Werner, District VI Swimming and Diving Chairperson

            1324 Appletree Circle

            State College, PA 16803