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Statement of interest for the race 2017

Complete the form below to register your interest in participating in the 2nd Swim the Canal 2017.

Fill the fields in capital letters.


FIRST NAME:
LAST NAME:
DATE OF BIRTH:
GENDER:
SPORT CLUB
ADDRESS:
CITY:
COUNTRY:
TELEPHONE:
E-MAIL:
SPAM FILTER: Finish
Roll the swimmer to the end, in order to send the form.

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