MQI-Stephan Miermont Clinic Registration
Fri Sep 1-Sun Sep 3, 2017 synchro clinic with Stephan Miermont and other special guest clinicians. Hosted by Meraquas of Irvine at Woollett Aquatics Center 4601 Walnut Ave, Irvine, CA. Registration is open until August 27.

Make checks payable to: Meraquas and mail to 25101 Mammoth Circle, Lake Forest, 92630. Payment must be received by August 28.

For more information please contact CandyHipp14@gmail.com.

Please complete the form below:

Swimmer's name (First & Last)
Your answer
Swimmer's birth year
Used to calculate synchro age
Your answer
Swimmer's synchro experience/level
For example Novice/Int/AG? How many years swimming synchro?
Your answer
Parent's name (First & Last)
Your answer
Parent's email
Your answer
Parent's cell phone
Your answer
Insurance Company
Your answer
Insurance Policy/Group #
Your answer
Insurance Company Phone #
Your answer
Health info / dietary restrictions:
Describe any allergies (food, medication, etc.)
Your answer
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