2019 Point to La Pointe Open Water Swim - Safety Paddler Registration Form

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Email *

Name *

Phone Number *

Please provide the best number for you on the day of the race.

Emergency Contact Name *

Emergency Contact Phone Number *

Mailing Address *

Please list any medical conditions and/or allergies that could affect you during the race.

Please include any and all things such as allergies to environmental factors that could be encountered, ongoing conditions that could affect your ability to operate and offer assistance, and/or recent and relevant history.

What is your t-shirt size? *

XXL

Other:

For lunch, which would you prefer?

Omnivore option

Vegetarian option

Clear selection

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