2012 UNITED STATES MASTERS SWIMMING, INC AND OHIO LMSC REGISTRATION
You can also register online and print copies of your membership card at usms.org
Please check only one:
Renewal Registration Current USMS #
Important: Register with the name you will use when you enter meets. PLEASE PRING CLEARLY!
Last Name First Name Middle Initial
City, State, Zip:
Home Phone: Work Phone: Fax #
Date of Birth Age: Gender: (circle one) Male Female
If no club is selected, you will be registered
as UNATTACHED. FEES:
UNATTACHED USMS fullyear registration - $35
(covers from Nov. 1, 2011 thru Dec 31, 2012
BGSC (Bowling Green Swim Club)
BGSU (Bowling Green State Univ. Masters) Fall Registration - $28
if registering for 2012 after Sept. 1, 2012
CiSC (Cincinnati Sports Club Masters)
CSMT (Columbus Sharks Masters) I wish to contributer $1.00 (or $_______) to
the International Swimming Hll of Fame
DAS (Dayton Area Sharks) Foundation. I have added this amount to
my 2012 registration fee.
DISC (Discovery Swim School)
DRM ( Dayton Raiders Masters) I wish to contributer $1.00 (or $_______) to
the USMS "Swimming Saves Lives" Fund.
DYD (Downtown YMCA Dolphins) Foundation. I have added this amount to
my 2012 registration fee.
HMSA (Hancock Masters Swimming)
HURY (Hilliard YMCA Hurricanes) TOTAL FEES ENCLOSED $ __________________________
MHHC (McConnell Masters) Make checks payable to: OHIO LMSC
NAM (New Albany Aquatics Club) Mail your check, and a SASE (self-addressed, stamped envleope) and this
completed form to:
OHSP (Ohio Splash) Laura Wright
OUMS (Ohio University Masters Swim Team) Ohio LMSC Registrar
SPY (Springfield YMCA) 312 East Mulberry St.
SWOM (Southwest Ohio Masters) Lancaster, OH 43130
ABM (Anderson Barracuda Masters)
BAY ( Blue Ash YMCA)
CMM (Cincinnati Marlin Master) RELEASE FROM LIABILITY
EBCY (East Butler County YMCA I, the undersigned participant, intending to be legally bound, hereby certify that I am physically fit and
MCYM (Miami County YMCA Masters have not been otherwise informed by a physician. I acknowledge that I am aware of all the risks
MHSW (Mercy Healthplex Sea Wolves) inherent in Masters Swimming (training and competition), including possible permanent disability or
MRM (Miami Redfin Masters) death, and agree to assume all those risks. AS A CONDITION OF MY PARTICIPATION IN THE
RAYS (Mason Manta Ray Masters) MASTERS SWIMMIN PROGRAM OR ANY ACTIVITIES INCIDENT THERETO, I HEREBY WAIVE
UCM (University of Cincinnati Masters) ANY AND ALL RIGHTS TO CLAIMS FOR THE LOSS OR DAMAGES, INCLUDING CLAIMS FOR
WTRC (Washington Twp. Rec Center) LOSS OR DAMAGES CAUSED BY THE NEGLIGENCE, ACTIVE OR PASSIVE, OF THE FOLLOWING:
XTC (Xavier Triathalon Club UNITED STATES MASTERS SWIMMING, INC., THE LOCAL MASTERS SWIMMING COMMITTEES,
**Other________________ THE CLUBS, HOST FACILITIES, MEET SPONSORS, MEET COMMITTEES, OR ANY INDIVIDUALS
SYL (Sylvania Masters Swim Club) OFFICIATING AT THE MEETS OR SUPERVISING SUCH ACTIVITIES. In addition, I agree to
UAMS ( Upper Arlington Masters Grey Bears) abide by and be governed by the rules of USMS.
UAR ( Up and Running Swim & Tri)
WSM (Wright State Masters) SIGNED:
Ohio LMSC communications are now only available via the LMSC website (http://www.ohiolmsc.org/) and e-mail.
*NOTE on "OTHER": To be added to this list, the Benefits of Membership include: A sub
registrar must have a completed registration form
and the annual fee of $35.
** for new workout groups with SWOM, registrar
needs the name of a contact person.