Division or Section Name: Long Island Division Event: INDIVIDUAL Certified by: Linda Wangner Title: Secretary EVENT Address: 29 Euston Road, Garden City, NY E-Mail: LWANGNER@aol.com QUALIFYING Phone #: 516-741-5809 FAX #: FORM Nbr. of Entries 23 Nbr. of Qualifiers 6 Date of Qualifying Event: Place Membership # Name (Last, First & Middle Initial) Club Qual.* Auto.* Birth Yr Classification New Classification 1 Wan, Nicholas NSFC Q1 1991 2 Fishler, Cliff NSFC Q2 1992 3T Thorne, Christian NSFC Q3 1994 D 07 3T Hahn, Justin MFC Q4 1991 5 Lindquist, Michael Comm HS Q5 1991 6 Berman, Reuben NSFC Q6 1991 7 Liu, Jay NSFC 1991 E07 8 Qualified Jr. Chan, Marcus NSFC 1992 9 Philippou, Eric NSFC 1991 10 Kim, Minjun NSFC 1994 10T Wan, Justin NSFC 1994

12 La Rosa, Anthony IFA 1991 13 Bram, Richard IFA 1992 14 Soria, Romeo V MFC 1991 15 Maiarelli, Nicholas IFA 1994 16 Baracks, Josh MFC 1992 17 Horiiuchi, Kenji NSFC 1991 18 Philippou, Jonathan NSFC 1993 19 Shaw, Michael MFC 1993 20 Demarchena, Alexnader IFA 1992 21 Goidell, Matthew, J IFA 1993 22 Weiss, Richard Salle Tanya 1994 23 Cohen, Alex IFA 1992 24 25 26 27 28 29 30 31

32 33 34t 34t 35 36 Athletes must be U.S. Citizens or Permanent Residents Enclose membership(s)