London Region Open Water Champs 2019

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This entry form should only be used by Enfield Swim Squad members.

PAYMENT FOR ENTRIES WILL BE TAKEN BY DIRECT DEBIT. IF YOU HAVE NOT YET SIGNED UP FOR THE ESS GALA DIRECT DEBIT SCHEME, PLEASE DO SO HERE: https://pay.gocardless.com/AL0000NJ5PHFXB.

Email *

Gender *

Please state whether you compete in male or female events.

Male

Female

Surname *

Please enter ATHLETE'S SURNAME as registered with Swim England.

First Name *

Please enter ATHLETE'S FIRST NAME as registered with Swim England.

Swim England Registration Number *

Go to www.swimmingresults.org/biogs to find your number. If you are not yet registered, please enter 00000.

Date of Birth *

YYYY

Competition Age *

Please state your age as at 31st December 2019.

Contact Mobile Number *

Event

Please choose which event you wish to compete in. If you are looking to qualify for Open Water Nationals, please read the competition conditions carefully before making your choice.

2k (12+)

3k (14+)

5k (16+)

Clear selection

Name of your squad: *

Squad codes: HPE=High Performance, MDX=Middlesex, JPE=Junior Performance, JPO=Junior Potential, MAS=Masters

I CERTIFY THAT I HAVE READ AND UNDERSTOOD THE COMPETITION CONDITIONS. I AUTHORISE ESS TO COLLECT £21 VIA DIRECT DEBIT. *

The entry fee take part is £20. ESS will charge an additional £1 per swimmer to cover admin cost. IF YOU HAVE NOT YET SIGNED UP FOR THE ESS GALA DIRECT DEBIT SCHEME, PLEASE DO SO HERE: https://pay.gocardless.com/AL0000NJ5PHFXB.

Please tick here

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A copy of your responses will be emailed to the address you provided.

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