2015/16 Member Registration Request
ROCKSWIM Member Registration Request
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First and Last Name *
Preferred email address *
Date of Birth *
Day/Month/Year
Age as of January 2016 *
Sex *
I am a returning member of ROCKSWIM *
Required
Would you like to receive a 15% discount of regular priced merchandise from "Take the Plunge" *
If you click yes, your name only will be given to Take the Plunge
Required
What is your favourite workout? *
What is your swimming goal for the 2015/2016 season? *
Would you consider a competition as a goal in your swim training? *
Group you were swimming with at the end of last season
If returning member, see "Swim Workouts" web page for Group times from last season
What is your intended method of payment for pool entry? *
This information will be used to better serve our membership as ROCKSWIM provides the coaching while the AQ provides the facility.
Street Address
City &  Province
Postal Code
Telephone Number
I have read and agree to the Release, Waiver and Assumption of Risk Agreement (see Step 1 above) *
Required
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