STREL SWIMMING REGISTRATION FORM

STREL SWIMMING REGISTRATION FORM

Please enter your details below and we will send you an email confirmation after we have received it.
TRIP NAME - LOCATION
TRIP DEPARTURE DATE

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
GUEST INFORMATION

PrefixFirst NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearFormat: DD-MM-YYYY
Email (Type it twice!)

Confirmation Emailjohn.swimmer@gmail.com
Mobile (Cell) Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
PROFILE INFORMATION
Do you have any pre-existing medical condition? Please descibe.
Do you have any dietary restrictions or allergies? Please specify.
Please specify your average swimming time in minutes per mile or kilometre.
( ie. 15-20-25-30)
Swimming distanance unit (km or mile)
Swimming experience
EMERGENCY CONTACT INFORMATION

Please provide your close contact person's details below in case we need to contact them.
PERSON'S DETAILS

PrefixFirst NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Emergency contact relationship
OTHER
Where did you hear about us
Hotel room details (sharing with someone) and any other booking notes
Should be Empty:

PROFILE INFORMATION