The BRR Registration Form

The BRR Registration Form

July 3, 2020 - Smugglers Cove to Bird Rock & back... Once your registration is completed, you will receive an email with further updates. Cost is $160 EC or $60 USD... If you are interested in the combination package with the 3K or 5K races then complete the area on this form. Special combination rate is $200 EC or $75 USD.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*

MonthDayYear
Date
Gender

MaleFemale
I will be swimming The BRR...*
Emergency Contact*
Name, Phone Number, Address, Relationship
Medical Conditions*
*No one should undertake any competitive open water event unless s/he is physically fit, in excellent health and fully expects to complete the distance entered.
T-Shirt Size - Receive a free t-shirt with your registration prior to May 1, 2020! You may purchase extra T shirts for $35EC each. Please note your size below and email us for information regarding extra t-shirts. (By noting your size you agree to payment for the shirt)

S - smallM - mediumL - LargeXL - Large
I would like to purchase the following number of extra shirts (at the additional cost of $35 EC each).
Please indicate the size shirt and number (ex. S-5, L-1, M-3)
DISCLAIMER and WAIVER OF LIABILITY: I hereby declare thatI am a competent swimmer and that there are no medical reasons why I should notparticipate in the open water swim session. I agree to participate at my ownrisk, the extent of which I fully appreciate. I accept that no liability whatsoever will attach to the sessionorganizers for any injury, death, loss, and/or any other claim whatsoever andhowsoever arising by reason of my participation in the open water swimsession. I agree for my details to beheld electronically for the purpose of organizing, coaching, and future events.They may not be provided to any other organization or use for any otherpurpose.Please sign the form and present to the organizers.
NO FORM = NO SWIM
Signature - type your full name*
Your name here acts as signature and agreement to Disclaimer.
Date of Signature*

MonthDayYear
DateHourMinutesAM/PM Option
Please verify that you are human*
Should be Empty: