Observation Request/Payment MIAA Fall D1 States 11/9/25

Observation Request and Payment for MIAA Fall D1 States-11/9/25
This form is to be used by a USA Swimming athlete member wishing to have their race observed by a USA Official and entered into the SWIMS database.

MEET: MIAA Fall D1 States 11/9/25

Please complete this form and submit it with a $5.00 payment per event by November 8st at 5pm.
First Name*
Middle Name or initial (if none type*)*
Last Name*
Date of Birth*

MonthDayYear
Date
High School *
USA SWIMMING CLUB NAME*
USA SWIMMING ID# *
Email*
example@example.com
Cell Phone Number*
Please enter a valid phone number.
Swimmers are only allowed 2 individual events and two relay lead off times (or 1 individual event and three relay leadoffs). Please indicate the events for which the swimmer is entered and wants observed.
Check off the events you would like observed:

200 Medley Relay (lead off)200 yd Freestyle200 yd Ind Medley50 yd Freestyle100 yd Butterfly100 yd Freestyle500 yd Freestyle200 yd Freestyle Relay (lead off)100 yd Backstroke100 yd Breaststroke400 yd Freestyle Relay (lead off)
RELAY: If entire relay is made up of USA Swimmers from the same team and you want the relay entered list the relay name and all four names in order of swim:
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Events to be observed
$5.00 Quantity

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Observation Request and Payment for MIAA Fall D1 States-11/9/25