St Lucia Channel Swim Information Request

St Lucia Channel Swim Information Request
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
I am interested in swimming:*

St Lucia Channel (from St Lucia to Martinique - 21miles/33km)A shorter swim along the cost of Saint Lucia (less than 15 miles/24km)A longer swim along the cost of Saint Lucia (15miles/24km or longer)Other options that might be available in the region
Interested in swimming the channel as:

A Solo SwimmerA Relay Team
I would like to attempt the swim:*

During the year 2021During the year 2022Future events or years
I understand by submitting this form, I agree to receive future emails regarding the St Lucia Channel Swim and the events hosted throughout the year.
Submitting this form in no way confirms my registration or participation in the St Lucia Channel Swim or other events.
Date*

MonthDayYear
DateHourMinutesAM/PM Option
Should be Empty: