I WOULD LIKE TO ENTER A TEAMREGISTER INDIVIDUALLYSUBMIT A GENERAL ENQUIRY
COMPETITION NIGHT SUNDAYMONDAYTUESDAYWEDNESDAYTHURSDAY
COMPETITION CATEGORY MEN'SMIXEDWOMEN'S
PREFERRED VENUE BOX HILL - AQUALINKBOX HILL - KINGSWOODBURWOOD (HQ)CAMBERWELL (HQ)CARLTON NORTH (HQ)COLLINGWOODHAWTHORN (HQ)VERMONT SOUTH
HOW DID YOU HEAR ABOUT US? FLYER/POSTERONLINE ADVERTISEMENTREFERRALSOCIAL MEDIAOTHER
FIRST NAME (Required*)
SURNAME (Required*)
HOME/WORK PHONE NUMBER
MOBILE PHONE NUMBER (Required*)
EMAIL (Required*)
HOME/POST ADDRESS
MESSAGE