Ultramarathon Swim Series Swimmer Entry Form

Ultramarathon Swim Series Swimmer Entry Form
What event(s) are you applying for? (you may select multiple)
Name

First NameLast Name
Email
example@example.com
Gender
Hometown
Home Country
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Cell Phone Number
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of Primary Team, School, Company or Organization You Are Representing
Who will serve as your coach on this swim?
Coach's name. This could be a spouse or family member or professional coach.
Emergency Contact Name

First NameLast Name
Emergency Contact Cell Phone Number
Upload Headshot

A headshot is a tightly cropped photo of the face, from the shoulders up.
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Swimming Photos

Select photos of your swims and participation in previous events
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List 3 Hardest/Longest Marathon or Extreme Swims with Dates, Distances, Places, and Times
Race #1
Race Name of race* Distance Distance* Location Location* Date Date* Time Hours* Minutes Seconds
Race #2
Race Name of race* Distance Distance* Location Location* Date Date* Time Hours* Minutes Seconds
Race Name of race* Distance Distance* Location Location* Date Date* Time Number*
Race #3
Race Name of race* Distance Distance* Location Location* Date Date* Time Hours* Minutes Seconds
Race Name of race* Distance Distance* Location Location* Date Date* Time Number*
1-3 Paragraph Biography About Yourself Including Your Marathon Swimming Experience
List Any Other Athletic or Professional Achievements You Would Like Us to Consider in Your Application
Website or Blog URL
Please paste link (URL)
Instagram
Please paste link (URL)
Twitter
Please paste link (URL)
Facebook Profile
Please paste link (URL)
YouTube Channel
Please paste link (URL)
T-shirt Size
Signature
Should be Empty: