REGISTRATION FORM
CHRISTMAS DAY FUN SWIM 2017
FIRST NAME *
Your answer
SURNAME *
Your answer
ADDRESS *
Your answer
CONTACT NO (mobile) *
Your answer
EMAIL ADDRESS *
Your answer
WILL YOU BE JOINING US AT BLACKROCK OR TAKING TO THE WATERS IN YOUR LOCAL AREA *
(participants who wish to complete their swim at their local beach, river etc are welcome to do so)
SPONSORSHIP AND/OR DONATIONS WELCOME, PLEASE TICK YOUR PREFERENCE *
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