CLUB NAME:

CLUB ADDRESS -- STREET:

CLUB ADDRESS -- CITY: STATE: --None-- CA NV ZIP:

COMPETITION SITE:  

To qualify for travel assistance, the club’s senior swimmers must attend at least two Pacific Swimming Senior or Senior T & F meets during the 12 months prior to the National level meet.  Further determination of eligibility will be made by the Senior Committee.  Clubs may receive travel assistance for one coach for a maximum of two national level meets each year.  The reimbursement level will be the amount of the determined airfare for the meet as approved by the Pacific Swimming Board of Directors for athletes who are attending the meet.

(Reimbursement checks will be made payable to the “club”)

Meet Attended: --None-- USA Spring Championships Speedo Junior Championships US Olympic Trials ConocoPhillips National Championships Short Course National Championships Open Water Nationals

Name at least one of your athletes attending the competition:

Names and dates of at least two (2) qualifying Pacific Swimming Senior or Senior T & F meets your club has attended in the past  twelve (12) months:
Qualifying Meet 1):
Qualifying Meet 2):

Please check this box to certify that the information you are submitting is true:

Print a copy for your records before submitting.

You can also mail the printed form to: 
Pacific Swimming Senior Committee, PO Box 591185, San Francisco, CA 94159

All requests for reimbursement must be submitted by December 31^st, please submit promptly following the meet .

Return the form by online by pressing the "Submit" button below: