You must provide all fields marked in bold.

Personal Details

Surname:
First Name:
Club:	Please 4 character ASA code
ASA Registration Number:
Sex:	Male Female
Date of Birth:	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Telephone Number:
E-mail Address:	Note: For club entries this should be the e-mail address of the club entry co-ordinator. Confirmation of the entry will be sent to this address.
Address:
Post Code:
Is this a replacement for an earlier entry:	No Yes

Events

Please enter times in the boxes below for events you wish to enter. All entry times (25m) entered must have been achieved at a level 1/2/3 licensed meet since 1st October 2007, and must be stated to 2 decimal places.

Event	100m	200m	400m	800m	1500m
Freestyle
Backstroke
Breaststroke
Butterfly
Ind Medley

When you have completed the form, click on Submit below. Before clicking on Submit, you must indicate that you accept the Promoters Conditions and confirm that the above information is accurate. The next screen will confirm the information that has been recorded and calculate the appropriate entry fee. If this information is incorrect, you will have the opportunity to cancel your entry and start again.

I confirm that I have read and accept the Promoters Conditions, the swimmer above is an eligible competitor and the above entries are in accordance with the conditions of the South East Region Championships.

Remember my personal details. If you check this box your telephone number, e-mail address, address and club will be saved for future entries. You may find this useful if you are submitting multiple entries for a club.

Please be patient when you click submit. Processing of the information may take some time.

To clear the form of all information and start again, click the Reset button below.