2005 ROOKIE ROWERS REGATTA APPLICATION FORM

Print and mail this form along with a check for the total entry fee payable to Penn AC Rowing Association to Gabi Cipollone, 208 Williamsburg Road, Ardmore, PA 19003-3104.

Name:

Rowing Club:

Mailing Address:

Email Address:

Home Phone Number:

Cell Phone Number:

Age on December 31, 2005:

First Event and Applicable Fee:

If Not a Single, Other Rowers in the Boat and Their Age on December 31, 2005

Second Event (if any) and Applicable Fee:

If Not a Single, Other Rowers in the Boat and Their Age on December 31, 2005