Full Name*

Gender*
Male
Female

Age Category*

13-15 yrs	45-49 yrs
16-19 yrs	50-54 yrs
20-24 yrs	55-59 yrs
25-29 yrs	60-64 yrs
30-34 yrs	65-69 yrs
35-39 yrs	70+ yrs
40-44 yrs

Swim Distance*
-- Please select -- 500m 1km 2.2km

Swim Time*

Swim Location*
-- Please select -- Oceanswim Saltwater Pool Chlorine Pool Freshwater

Other Location

Swim Date*

Link to an online GPS file, movie or photos of you completing the swim