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2024 Online Lazers Registration From! (Form 1 of 2)
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Swimmer's Family Last Name:
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Swimmer's First Name:
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Swimmer's Last name:
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Email Address #1:
Email Address #2:
Email Address #3:
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Phone Number #1:
Phone Number #2:
Phone Number #3:
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Street Address (Number + Street Name):
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City (Macungie):
State (PA):
Zip/Postal Code:
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Swimmer's Gender:
Male
Female
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Swimmer's Age as of 5/31/2024:
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Swimmer's Birthdate:
Jan
Feb
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Swimmer's Shirt Size:
Youth Small
Youth Medium
Youth Large
Youth X Large
Adult Small
Adult Medium
Adult Large
Adult X Large
Adult 2X Large
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Parent/Guardian #1 First Name:
*
Please ENTER Parent Last Name.:
Parent/Guardian #2 First Name:
Parent's Last name:
* indicates required fields