Hosted by the Long Beach Grunions
Belmont Olympic Plaza in Long Beach, California
December 4-6, 2004 (Saturday to Monday)
Sanction number: 334-035
Online Registration Form
Personal Information
First Name
Last Name
Address 1
Address 2
City
State
Zip Code
Phone Number
E-Mail Address
(You will receive an e-mail confirmation)
Gender:
Male
Female
Birth Date:
(MM/DD/YYYY)(4-digit year)
Club Name
USMS #
T-Shirt Size
(1 free t-shirt included)
Small
Medium
Large
X-Large
XX-Large
Swim Meet Social
Yes, please sign me up for the meet social being held at La Palapa (adjacent to the pool) on Saturday, December 4th, at 5:00 PM. I understand that the cost is $15.00 and this amount will be added to my meet registration total.