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Pickering Masters Swim Club
Step One: General Information
Name:
*
Email:
*
Phone:
*
Address:
*
City / Town:
*
Postal Code:
*
Emergency Contact Name:
*
Emergency Contact Phone Number:
*
Birthday
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Gender
*
Male
Female
Please explain your past swimming experience and what your personal goals are from masters swimming.
*
Do you have any health problems that the Executives or Coaches should be aware of?