Swim Melbourne Mahi Masters

Trial Workout

Step 1 of 3

Biographical
Waiver
Payment
Payment
Receipt

Instructions Fill in 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. Print this coupon and bring it with you to a workout for your free trial.

* Starred fields are required

First Name *

Middle Name

Last Name *

Birth Date *

Cell Phone *

Texting Cell

Mobile provider

Email *

Country *

Street *

Street 2

City *

State *

ZIP Code *

2024 U.S. Masters Swimming (USMS)

USMS Club

Member ID

Use all 10 digits, i.e. 3348-0000A
Register for USMS | Retrieve USMS ID

T-Shirt Size

[Adult]

XXL

Emergency Contact

Name *

Relation

Phone *

Name 2 *

Relation 2

Phone 2 *

Please tell us your interests in swimming: •

Fitness Swimming

Competitive Swimming

Triathlon

Friends/Camaraderie

Lose Weight

Other

Trial Workout Information

Date Attend

(mm/dd/yyyy)

Facility attend

Sherwood Park Pool, Melbourne Cocoa Beach Aquatic Center (Seasonal), Cocoa Beach Fee Ave Park Pool (Seasonal), Melbourne other