Lodi Swim Club

Online Registration

Instructions:  To become a Lodi Swim Club member, please complete this 2-step registration form.  On step 2 you will be asked for your credit card (Visa, MasterCard, Discover) information.  Once you complete step 2 and submit the form, you are immediately eligible to participate


ATHLETE INFORMATION:
* Starred fields are required
First Name *
Middle Name *
Last Name *
Create Password
Sex *  
Birth Date (mm/dd/yyyy)
Phone
Home
Cell
Texting Cell Mobile provider Same as Cell Number
Add Another Texting Cell Number
Email *
Add Another Email Address
Street *
Street 2
City *
State *
ZIP *
Parent/Guardian   1)   2)
Emergency Contact (Parent, Spouse, etc)
Name *   Relation
Phone *
Name 2 *   Relation 2
Phone 2 *

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