First Name: * Last Name: *
Phone:
Address1: *
Address2:
City: * State/Province: *
Zip/Postal Code: *
Country: *
Email: *
Your Swim Date: *
Swim Time: 8:30 am Structured 9:30 am Natural 12:45 pm Structured 1:15 pm Sea Lion 1:30 pm Natural 3:00 pm Sea Lion 3:00 pm Structured *
Number of Swimmers in Your Party: *
Who Did You Swim With: Bella Bob Dinghy Elvis Fiji Grace Jessica Julie Lotus LB Nica Sarah Squirt Wono Natural Unknown & Bella Bob Dinghy Elvis Fiji Grace Jessica Julie Lotus LB Nica Sarah Squirt Wono Natural Unknown & Bella Bob Dinghy Elvis Fiji Grace Jessica Julie Lotus LB Nica Sarah Squirt Wono Natural Unknown *
Check each group that applies: *
1st in water 2nd in water 3rd in water
Please Describe Your Appearance (Hair color, swim wear, etc.):*
Additional Comments: