Intention to Swim - 2024 Hancock Prospecting Queensland Championships

1
Swimmer Name* This field is required.
First Name
Last Name
2
Date of Birth* This field is required.
Date
Day
Month
Year
3
Contact Email - for confirmation* This field is required.
example@example.com
Email Verified
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4
Club* This field is required.
5
Which event are you registering your intention for?* This field is required.
Please Select
Please Select
Event 227 Girls 17-18yrs 400 Freestyle
Event 228 Boys 17-18yrs 400 Freestyle
Event 239 Girls 13-14yrs 1500 Freestyle
Event 240 Boys 13-14yrs 800 Freestyle
6
Are you intending to swim this event?* This field is required.
YESNO
7
Please confirm in writing that you are withdrawing from this event.* This field is required.
8
Name of Person Completing Form* This field is required.
9
Contact Number for Person Completing Form* This field is required.
Please enter a valid mobile phone number.
10
Signature of person completing form* This field is required.
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