CLEVEDON LONG SWIM

LATE ENTRY FORM

Please fill in all details on the form opposite.

TIMES & ROUTE below.

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Name

Email

Phone

Date of birth

Gender

Female Male

Emergency contact & phone no

Do you have any conditions or needs affecting your safety

Yes No

Tell us the conditions or needs affecting your safety

Novices only allowed in the Leisure wave

Class

Skins Wetsuit

Experience

Novice Intermediate Expert

Wave

Leisure Fast

Terms & conditions

I/we have read and agree to the event terms & conditions

Fee £

Card details

Clevedon Open Water

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