Booking

Please fill in every field.

1. First Name:
2. Last Name:
3. Email Address:
4. Street and Number
5. Suburb:
6. State: Aus Capital Territory Northern Territory New South Whales Queensland South Australia Tasmania Victoria Western Australia
7. Post code:
8. Telephone No
9. Mobile No
10. Course Date: Brisbane 7-7 Sep Sydney 14-14 Sep Mornington, VIC 21-21 Sep Melbourne 21-21 Sep Brisbane 6-7 Sep Sydney 13-14 Sep Melbourne 20-21 Sep Adelaide 26-28 Sep Mackay 1-2 Nov
11. Message:

Please supply us with the following personal information to assist the instructors to adjust the delivery of the workshop to suit your needs.

1. Date of Birth: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January Febuary March April May June July August September October November December
2. Gender Male Female
What types of swimming are you interested in? Tick all that apply.
1. Therapeutic
2. Recreational
3. Competitive
4. Pool
5. Open water
6. Triathlon
3. How regularly do you swim? Never Occasionally Weekly 3+ Times weekly
4. What is your background in swimming and other sports?
5. How confident are you in deep water? Not at all Somewhat Extremely
6. List any past and present injuries, medical conditions and medication
7. Is there anything else you wish the instructors to be aware of.
8. What is your main aim for the weekend?
9. By typing "AGREE" I confirm that I have supplied full and accurate information and agree to the conditions detailed below.