Conejo Valley Multisport 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/Primary *
Work/Secondary
Cell/Other *
Email *
Street *
Street 2
City *
State *
ZIP *
2017 U.S. Masters Swimming (USMS) Club/Team Affiliation
Club/Team (Maximum of 5 alphanumeric characters)
Club/Team Name
Member Number use all 10 digits, i.e. 3348-0000A
Register for USMS | Retrieve USMS Number
USAT Number   Exp. Date
T-Shirt Size  (Adult)          
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 *
Trial Workout Information
Date Attend (mm/dd/yyyy)
Facility attend Agoura High School Track, Agoura Hills
Cal Lutheran University Comm. Pool (aka CRPD POOL), Thousand Oaks
Cal Lutheran University Pool , Thousand Oaks
Lake San Antonio
ProActive Sports Performance, Westlake Village, Ca 91361
Rancho Simi Community Park Pool, Simi Valley
Thousand Oaks High School Pool (TOHS), Thouand Oaks
other

Problem with this registration?

Powered by ClubAssistant.com   ©2003-2017   Page execution time: 80 ms