Test Registration Form

Fields marked with an * are required.

If you would like to take part in our event, please fill in your details in this Event Registration Form below and you will be automatically registered. Event registration should be completed at least two (2) days prior to the event.

First Name

Last Name

Email Address

Mobile Phone

Yes, I have read and understood the Club Handbook and agree to be bound by it’s rules and regulations

Click here to view/download the handbook

I would be interested in volunteering in the following areas *

Canteen Time Keeping Bar Marshalling BBQ Happy to help out wherever

Note that all members may be randomly rostered on. The club is run by volunteers so all club members need to help out to some degree.

Timed Swimmers

How many swimmers (including little’uns) would you like to register?

Swimmer 1

I would like to enter a second swimmer

Swimmer 2

Is this swimmer a little-un?

Yes

First Name

Surname

Gender

Female

Male

Birth Date

Would this swimmer like to nominate for club captain?

Yes No

I would like to enter a fifth swimmer

Swimmer 5

Is this swimmer a little-un?

Yes

First Name

Surname

Gender

Female

Male

Birth Date

Would this swimmer like to nominate for club captain?

Yes No

Any further comments or anything we should be aware of?

Timed Swimmers

Swimmer 1

Swimmer 2

Swimmer 3

Swimmer 4

Swimmer 5