To: National YMCA Swimming and Diving Committee

Re: 2019 YMCA LONG COURSE CHAMPIONSHIP

Fax Number: 1-866-633-8996; Email Address: YMCAForms@comcast.net

From: ________________________________________

Contact Phone: _________________________________

Contact Email Address: __________________________

Number of Pages: __________

Date of Transmission: _______

This cover sheet must be the FIRST page of the fax or email attachment.  NO OTHER COVER sheet should be included.

The only document to be Faxed/Emailed is your:

Signed CERTIFICATION, ELIGIBILITY & RELEASE DECLARATION Form

Note: Do not Fax/Email your Insurance Certificate. Send the Certificate to YUSA