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RELAY All-American Request Form RELAY ALL AMERICAN CERTIFICATE and PATCH REQUEST FORMS



New RELAY ALL AMERICAN certificates have been created (beginning with 2006) to capture the memory of your
great swim in achieving a NUMBER ONE USMS TOP TEN TIME for YOUR RELAY. When requesting a patch and a
certificate, the following information should be included:

FIRST AND LAST NAMES OF ALL FOUR MEMBERS OF THE RELAY:

1) ______________________________________________________________

2) ______________________________________________________________

3) ______________________________________________________________

4) ______________________________________________________________


RELAY EVENT:

MEN or
WOMEN or
MIXED (Circle one)


RELAY DISTANCE:

200

400

800
(Circle one)


RELAY TYPE:

FREE or
MEDLEY (Circle one)


TIME OF RELAY:

_________________________


RECORD TYPE (if applicable): __________________

If a specific record was broken (national/world/zone) and if you want the record title printed on the certificate,

please identify the type of record broken.


COURSE:


SCY or
SCM or
LCM (Circle one)


AGE GROUP:

____________________

For yards, the age of the youngest member shall determine the age group 18+, 25+, 35+, 45+, 55+, 65+, 75+,

85+, 95+, etc.
For all meters, the aggregate age of the four relay team members shall determine the age group. (72-99,
100-119, 120-159, 160-199, 200-239, 240-279, 280-319, 320-359, 360-399, etc.

TEAM/CLUB NAME:

_________________________________________________


YEAR/DATE on which the ALL AMERICAN swim was achieved: ________________


Send Patch and Certificates to:

NAME: ___________________________________________

ADDRESS: ________________________________________
ADDRESS: ________________________________________




Mail Payment ($5.00 for each member) to:

USMS
P.O. Box 185
Londonderry, NH 03053-0185

_________________________________

Questions: Please contact Ginger Pierson at:
gingerp@qwest.net