NAME OF ATHLETE: __________________________
Total Number of Laps Swam: _________
INLAND EMPIRE WATER POLO
NJO FUNDRAISER
Money Due to IEWP on 6/30/2014
Instructions: We will have a swim-a-thon on Sunday 6/22/2014 @ 8:00am @ Chaffey High School. The swim-a-thon runs exactly 1 hour
(arrive 15 minutes early). Each Participant will swim as many laps without stopping in 1 hour as they can. Each Swimmer must have their own
family member to count their laps. All donations are due to Inland Empire WP on June 30, 2014 @ Practice. You may request FLAT donations
or per lap donations. Good Luck! (ANY CHECKS MUST BE MADE TO IEWP)
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Phone Number
Flat Donation
Per Lap Donation
Total Amount
Collected
(yes/no)