Skills 2 Succeed Registration

Proudly Sponsored By –

www.SwimmersWorld.com.au

COMPLETE REGISTRATION BELOW

The Skills-2-Succeed Swim Clinic

with two of WA’s respected

female swim coaches

Deb Jones & Shelley Taylor-Smith

Give your child the edge!

As School Swimming Carnivals Are Fast Approaching

Skills 2 Succeed Swim Clinic

Registration form for Childrens Swim Clinic 27 - 30 January, 2015

Swimmer's Name*
First Last
Age Group You Swim In 2015
Club/Team
Mobile Ph. No.
Email Address*
Address
Street Address City State / Province / Region ZIP / Postal Code
Preferred Times
- Session A: 27-30 January 2015, 9.00-10:30am each day
- Session B: 27-30 January 2015, 11.00-12:30pm each day
Have you ever competed at State or Club Level Swimming?
- Yes
- No
Best Time 50 F/S
Best Time 100 F/S
Any Existing Medical Condition/s?
Skills 2 Succeed Clinic ea
Price: $ 220.00 Quantity:
Skills 2 Succeed Family ea
Price: $ 199.00 Quantity:
10% Discount Coupon

NOTE: I understand that places are limited and that, should I miss out, my full payment will be returned.