POTOMAC VALLEY SWIMMING OUTSTANDING ATHLETE
NOMINATION FORM FOR
2004 - 2005 CONSIDERATION

NOMINEE 
  		PVS # 
 
AGE GROUP: 
  		CLUB: 
 

CRITERIA FOR CONSIDERATION:

ACHIEVEMENT/EVENT EVENT PLACE
EXAMPLE: LC JUNIOR NATIONALS 100 Meter FREE FIRST
 
 		 
 		 
 
 
 		 
 		 
 
 
 		 
 		 
 
 
 		 
 		 
 
 
 		 
 		 
 
 
 		 
 		 
 
 
 		 
 		 
 
 
 		 
 		 
 
SUBMITTED BY: 
 
ADDRESS 
 :
PHONE: 
  		DATE: 
 

NOMINATIONS MUST BE RECEIVED BY FRIDAY SEPTEMBER 23, 2005 FOR CONSIDERATION.
See detailed instructions and criteria

MAIL TO: Outstanding Athlete
Potomac Valley Swimming
P.O. Box 3729
McLean, VA 22103-3729
 
Email To: 2005 Outstanding Athlete
 
FAX TO:301-977-6028 (this is only for Outstanding Athlete, PVS Fax is a different number).