EmailMe Form - 2019 WA Open ST Speed Skating Championships

Competitor Name

First Last

I am over 18 years of age?

Yes

No

Parent/Guardian Name

First Last

If under 18-years, this section must be completed.

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email Address

Confirm

Phone Contact

Include country or state code

Gender

Male

Female

Date of Birth

DD / MM / YYYY

Division

My best time this year (since January 2019 - if known)

All divisions - 500m

Club Name

Australian Racing Number

If you do not have a helmet cover, please write 'No Cover'.

Presentation Lunch

I will be coming.......

YES

NO

Acknowledgement

By ticking this box, I acknowledge the above named participant has read the AIR Code of Conduct and Member Protection Policy (available online at www.australianiceracing.org) and agrees to abide by it.

Submit Entry

Select 'Enter Me' and hit submit to submit your entry and be re-directed to the payment page.