2007 US NATIONAL SHORT TRACK CHAMPIONSHIPS February 22-25, 2007

TIME TRIAL STANDARD FORM

FOR ENTRY INTO SENIOR (ELITE) DIVISION

 1000m (9 LAP) Qualifying Time

Ladies Time  1:46.00          Men’s Time  1:38.00

 I have achieved the qualifying time in the following fashion:

 Check one:

 £        1.   Skated at or below the qualifying time at the 2006 U.S. National Short Track Championships in the time trial or mass start race.

£        2.   Skated at or below the qualifying time at any Short Track sanctioned competition by the ISU or an ISU member country in a time trial or mass start race between March 20, 2006, and the close of entry for the 2007 U.S. National Short Track Championships.  (Must submit a copy of an event card, include the Chief Timer’s name and Head Referee’s name, or copy of the protocol page which shows time, with this form.)

NAME (print)                                                                            BIRTH DATE                       

SIGNATURE                                                                            SEX:  M                F             

DATE                                                               Age as of June 30, 2006                           

**Time trial standard form, plus necessary documentation,  MUST    accompany entry form to above competition.