Chopper Swim 2019 - swimmer registration
Event Timing: 18 March 2019
Event Address: Waiheke Island
Contact us by email at olaf@chopperswim.nz
First Name *
Your answer
Last Name *
Your answer
Date of birth
MM
/
DD
/
YYYY
Phone Number *
Your answer
Email *
Your answer
Next of Kin name *
Your answer
Next of Kin - Relationship to me *
Your answer
Next of kin - Phone number (please include area codes) *
Your answer
I confirm that I am suitably qualified and physically capable of completing the event *
Required
I have read and understand the Participants' information sheet (https://www.chopperswim.nz/registration) *
I have read and understand the Acknowledgement Form (https://www.chopperswim.nz/registration) *
I understand and accept the risks inherent in my participation in the 2019 Westpac Chopper Swim and accept that primary responsibility for my safety rests with me
Please list any known health conditions that may be relevant
Your answer
Event Category *
Team Name (if applicable)
Your answer
Kayaker Name (if known)
Your answer
Boat/Boat Skipper Name (if known)
Your answer
I intend to wear a wetsuit *
Your approximate 10k swim time (solo swimmers only) hh:mm
Your answer
Any further comments *
Your answer
I CONFIRM THAT I WILL ADVISE EVENTS ORGANISORS OF ANY CHANGES TO THE ABOVE VIA EMAIL to olaf@chopperswim.nz *
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