Wahine Weekend @ Waipatiki

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* 1. Name ( First and Last)

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* 2. Club

Westshore

Ocean Beach Kiwi

Pacific

Waimarama

Other

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* 3. Age

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* 4. Surf Lifesaving Qualifications

First Aid Level 1

First Aid Level 2

First Aid Level 3

IRB Crew Award

IRB Driver Award

Instructor Award

Board Rescue Module

Rock Entry Award

Other (please specify)

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* 5. Email address

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* 6. Wishing to apply as a...

Participant

Instructor

Mentor

Wahine Weekend @ Waipatiki

Wahine Weekend @ Waipatiki

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* 1. Name ( First and Last)

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* 2. Club

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* 3. Age

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* 4. Surf Lifesaving Qualifications

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* 5. Email address

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* 6. Wishing to apply as a...

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* 7. Contact phone number

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* 8. Any medical or dietary conditions you wish to share with us

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* 9. Personal goals you wish to achieve by attending Wahine on Water Weekend.