Polar Bear Swim - Registration Form
Please complete the following form to register for Rotary Club of South East Nassau's Polar Bear Swim on Wednesday 10th January 2024 (12pm start) at Jaws Beach.

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Registration Form
Full Name *
Date Of Birth
E-mail Address *
Telephone Number
Which of the following best describes you? *
If you are a member of a Rotary, Rotaract, Interact or Early Act Club, please enter the name of your Club below.
If you hold any position (Director, Chair, etc.) within Rotary, please state this below.
What is your fundraising target? *
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