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
Date
GUEST INFORMATION*

PrefixFirst NameLast Name
Date of Birth*

DayMonthYear
Format: 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