Trial Request

Swimmer Details

First Name

Known As

Last Name

Date of Birth

Our minimum age for new trials is 6

Gender

Home Phone Number

Mobile Phone Number

Email Address

Retype Email Address

Address Line 1

Address Line 2

Address Line 3

Town/City

County

Postcode

Medical Details

Swimming Experience

Swims For Other Club

ASA Number

Please Select The Disciplines You Are Interested In

Masters

Open Water

Swimming

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