Long Course Championships Registration Form

Masters Swimming NT 2022 Long Course Championships Registration Form
Location: Parap Swimming Pool and Alice Springs

Race Dates: Saturday 17 September 2022 and Sunday 18 September 2022

Time: 3 pm (Sat) and 8 am (Sun)
Participant Information
Full Name

First NameLast Name
Age
As at 31/12/2022
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Phone Number

Area CodePhone Number
Email
example@example.com
Club Name

Street Address Line 2

CityState / Province

Postal / Zip Code
MSA Registration Number
Should be 6 digits
Emergency Contact Person

First NameLast Name
Emergency Person Phone Number

Area CodePhone Number
Relationship to Emergency Contact Person
Event Registration

*Entries are limited to five per person, with not more than four on one day.

Events on Saturday 3pm

Events on Sunday 8am

Rows	Select Events*	Entry Time
100m Butterfly
200m Backstroke
100m Freestyle
200m Breaststroke
50m Butterfly
100m Backstroke
1500m Freestyle (Qualifying times, no form strokes)