Roadrunner Aquatics

Online Registration

Step 1 of 3
Biographical Waiver Payment Confirmation
Instructions  To become a Roadrunner Aquatics member, please complete this 2-step registration form.  On step 2 you will be asked for your credit card (Visa, MasterCard) information.  Once you complete step 2 and submit the form, you are immediately eligible to participate.
* Starred fields are required
Swimmer Information
First Name *
Preferred (Nickname)
Middle Name *
Last Name *
Create Password
Sex *  
Birth Date * (mm/dd/yyyy)
School  
Phone
Home/Primary
Secondary
Cell/Other *
Email *
Street *
Street 2
City *
State *
ZIP *
Club/Team Affiliation
Club/Team (Maximum of 5 alphanumeric characters)
Club/Team Name
Member Number (14 characters formatted MMDDYYFFFMLLLL)
T-Shirt Size  (Adult)          
Parent/Guardian *   1)   2)
Emergency Contact (Parent, Spouse, etc)
Name *   Relation
Phone *
Name 2 *   Relation 2
Phone 2 *

Problem with this registration?

Powered by ClubAssistant.com   ©2003-2017   Page execution time: 23 ms