Confirm Intent to Swim - Distance Events

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* This field is required.
example@example.com
4
Club* This field is required.
5
Meet you are registering your intention for:* This field is required.
2026 National Preparation Meet
6
Which event are you registering your intent for?* This field is required.Female - 400m Freestyle Female - 400m IM Female - 800m Freestyle Female - 1500m Freestyle Male - 400m Freestyle Male - 400m IM Male - 800m Freestyle Male - 1500m Freestyle
Please Select
Please Select
Female - 400m IM
Female - 400m Freestyle
Female - 800m Freestyle
Female - 1500m Freestyle
Male - 400m Freestyle
Male - 400m IM
Male - 800m Freestyle
Male - 1500m Freestyle
7
Use other field* This field is required.Do not use this field
8
Are you intending to swim this event?* This field is required.
YESNO
9
Please confirm in writing that you are withdrawing from this event.* This field is required.
10
Name of Person Completing Form* This field is required.
11
Contact Number for Person Completing Form* This field is required.
Please enter a valid mobile phone number.
12
Signature of person completing form* This field is required.
Clear
Should be Empty: