ATHLETE NAME (L) _____________________(F)__________________(M) __________

STREET__________________________________________________________________

CITY______________________STATE __________ ZIP _________PHONE __________

BIRTHDATE _____________________ SEX  M  F     USA NUMBER ________________

OLD CLUB NAME ___________________________________________

NEW CLUB NAME __________________________________________

I understand that in order for me to represent my new USA club in a competitive event, 120 consecutive days must have elapsed without having represented any other USA club in USA competition. I also certify that I have no outstanding fees or debts with my old club and the above information is true and correct to the best of my knowledge and belief.

SIGNATURE ________________________________________

NOTE: Your new club will be notified of the date you may attach with them. Those swimmers transferring to UNATTACHED status will be transferred immediately.

SEND FORM AND $2.00 TRANSFER FEE (PAYABLE TO LAKE ERIE SWIMMING) TO: