40.30.3.3.4 - ELIGIBILITY CERTIFICATE University: Queen's University Sport: Water Polo - M Year: 2009-2010

Student #

Firstname Michael Alexander Matthew Eric Gregory Bliss Riley Stephen Ian Matt

Lastname Dalziel Demner Dermody Jones Kelley Man Millington Pariser Pinchin Thompson

Pos

Hgt 5-11 6-2 6-0 5-10 5-10 6-3 6-2 5-7 6-3 6-2

Wgt

Elig. Yr. 2 3 4 4 1 1 1 3 2 5

DOB 09/03/1991 03/12/1986 27/01/1988 13/01/1988 30/10/1985 21/07/1987 12/04/1989 15/12/1989 06/06/1990 27/06/1986

Course Biochemistry Law Mechanical and Materials Engineering Engineering Chemistry Political Studies Mechanical and Materials Engineering Geological Sciences Political Studies Philosophy Psychology

If presently ineligible, please indicate Study Yr. Home Town Prov. University Last Team with an "X" 2 Ancaster Ont. Queen's 6 Kingston Ont. Queen's 4 Stouffville Ont. Queen's 4 Hamilton Ont. Queen's 5 Beaconsfield Que. Queen's 5 Hamilton Ont. Queen's 3 Belleville Ont. Queen's 3 Ingersoll Ont. Queen's 2 Kingston Ont. Queen's 5 Hamilton Ont. Queen's

Signature of Director of Athletics or Designate

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Date _______________

Signature of Head Coach

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Date _______________

Signature of Registrar or Designate

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Date _______________

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Expected date of eligibility for Transfer or Professional