Southern California Aquatic Masters

Trial Workout

Step 1 of 3
Biographical Waiver Payment Confirmation
Instructions  Please fill out this form and submit it.  After you submit it, you will be sent to a page that has all your information printed on a coupon.  Please print this coupon and bring it with you to a workout for your free trial.
* Starred fields are required
First Name *
Preferred (Nickname)
Middle Name
Last Name *
Birth Date * (mm/dd/yyyy)
Phone
Home *
Work
Cell *
Email * Label
Add Another Email Address
Street *
Street 2
City *
State *
ZIP *
Employer * (Name of the company)
Profession
Street   Street 2
City   State   ZIP
Emergency Contact (Parent, Spouse, etc)
Name *   Relation
Phone *
Name 2 *   Relation 2
Phone 2 *
Interested in joining the Member Network?   Yes   Please send info
Club Name
Club Name
Trial Workout Information
Date Attend (mm/dd/yyyy)
Facility attend Culver City Municipal Plunge, Culver City
Echo Park, Los Angeles
El Segundo, El Segundo
Loyola Marymount University, Los Angeles
Redondo Union High School, Redondo Beach
Santa Monica - ONLY AVAILABLE TO SM RESIDENTS
University of Southern California, Los Angeles
Van Nuys Sherman Oaks City Pool, Sherman Oaks
Westwood Recreation Center, Los Angeles
other

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