Wellington Winter Championships 2016

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

11th and 12th June 2016 - Porirua pool

Hosted by

Sponsored by

About you

Your first name *

Your last name *

Street

Suburb

Town

Post code

Country

Your cellphone *

Please include the international code if from abroad

Your email address *

Gender *

Male

Female

Your nationality *

Please tell us your nationality for competition purposes

Your date of birth *

YYYY

Emergency contact information

Full name *

Relationship to you *

Their cellphone number *

Please include the international code if from abroad

Their home phone number *

Please include the international code if from abroad

Participation Grade, Entry Fees and Freediving New Zealand subs

We offer a "competition grade" which qualifies for AIDA rankings and a "recreational grade" for competitors who do not want their participation recorded against world rankings.

In addition to the entry fee, competition grade divers must be current members of Freediving New Zealand. Membership is 1 April 2016 – 31 March 2017. Check with your club's committee which membership scheme is applied within your club (club-based or individual).

Payment of competition fees should be made to Lazy Seal Freediving Club, Bank Account number 38-9004-0459813-00 with your name and WWC2016 as the reference for the payment.

Payment of the Freediving New Zealand subs should be made to Freediving New Zealand, Bank Account number 38-9007-0470620-00 with your name and Subs 2016 as the reference for the payment.

I want to compete in the *

Competition grade

Rec grade

I want to compete on: *

Competition fees are $20 for one day (no matter which day) and $40 for both days

Saturday morning

Saturday afternoon

Sunday

Required

Freediving New Zealand subs *

Competition Grade - Paid by the club

Competition Grade - Individually - 1 year - $100

Competition Grade - Individually - Just this competition - $50

Recreational Grade - no subs needed

I have already paid my subs for this year (1 April 2016 - 31 March 2017)

Agreement

I agree to being filmed/photographed throughout the competition and the footage being retained and used by AIDA, Freediving NZ or LSFC for promotional purposes. *

I have read the information sheet. *

I have paid my subs to Freediving NZ if I enter in the Competition grade. *

Diver's profile

Club *

Personal best, record - Dynamics

Personal best, record - Dynamics without fins

Personal best, record - Static

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms