Registration for Mediterra’s Swim Training Events Swim Event Registration Step 1 of 3 33% Participant InformationName Of Participant* First Last Email* Have you made a registration and payment for this event already?*YesNoYou don't have to fill in the rest of your personal information if you have already filled out a registration for this event previously, and you will just pay the remaining amount. Gender*FemaleMaleYour age at the time of training event...*Phone*Please include the country code.Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Your Training EventChoose the event type...*Private or Small Group TrainingOW Swim GroupOW Swim Clinic (1 day)OW Swim Camp (multi-day)Select your training scenario...*Single Lesson 60 minutesSingle Lesson 90 minutesLesson Series (over a few days)Weekly Lesson Series (over a few weeks)Select your training topic or event...*Custom Private TrainingPool Comfort SeriesNew Swimmer SeriesFreestyle FundamentalsFreestyle AdvancedDifferent StrokesSwim Club (4-week pass)Swim Club (single visit)Select your ow swim group...*Turner Lake OW Swim GroupAt which location?*Courthouse Fitness in Salem OregonMittleman Jewish Community Center in SW PortlandTurner Lake in Turner, OregonYou may pay the 4-week pass fee or a single visit fee now. Or you may complete this registration, enter $0 into the payment amount, then pay in cash at your first attendance. Just choose "I have made other payment arrangements..." at the end of this form. Which Swim Club session do you plan to attend?Which instructor will you work with?*Coach Jamee SmallCoach Mat HudsonNo PreferenceAre you a current member of Courthouse Fitness?*YesNoNo, but I may be interested in membershipAre you a current member of MJCC?*YesNoNo, but I may be interested in membershipWhat is the starting date for your training event?*Write either the scheduled starting date for the group training event, or the date you have agreed upon with your instructor for private lessons. Select your OW Swim Clinics...* OW Clinic at Hagg Lake, July 12 OW Clinic at Foster Lake, July 26 OW Clinic at Hagg Lake, Aug 9 OW Clinic at Crescent Lake, Aug 23 Select your OW Swim Camp...*Kaş Turkey, June 2021Kaş Turkey, September 2021Enter your training payment amount...* The non-refundable deposit is $60 per person. You may pay the DEPOSIT amount or more, pay the FULL AMOUNT, or pay the REMAINDER of your balance. Refer back to the Private Training page for lesson prices. Enter your OW Swim Group payment amount...* You may make a non-refundable payment of $30 for a month (approx 4 swims per month), or $15 for a single 'drop-in' swim. You may pay by card at the end of this registration or cash in-person. Enter your OW Swim Clinics payment amount...* The non-refundable deposit for each swimmer is $30 for each clinic. You may pay the DEPOSIT amount or more, pay the FULL AMOUNT, or pay the REMAINDER of your balance. Refer back to the swim clinic page for prices. Enter your OW Swim Camp payment amount...* The non-refundable deposit for each swimmer is $150. You may pay the DEPOSIT amount or more, pay the FULL AMOUNT, or pay the REMAINDER of your balance. Refer back to the swim camp page for prices. Total Payment $0.00 Lodging At CampRoom Request*I will make my own lodging arrangements.I would like to request a room.Room Type*1 person, single bed2 people, two single beds2 people, 1 double bedPlease understand that we do not arrange roommates for our guests. If you would like to share a room you will need to invite another swimmer or companion to join you.My room companion will be...*Who will you be sharing a room with? Lodging arrival and departure dates are...*It may be possible to stay extra nights are our chosen lodging. Enter the dates you intend to arrive and depart on. Any additional note about your lodging request? PaymentTotal payment you intend to make... $0.00 If this is not correct, you may go back and edit the payment amount on the previous page. Please read our Privacy Policy. By filling out this registration form, you agree to trust us with very limited use of your personal your data to provide coaching services to you. We do NOT share your information with anyone outside our administrators. You also agree to be added to a mailing list that enables us to send you information about this particular training event and Mediterra's services in general. You are welcome to unsubscribe from the list at any time by following the link at the bottom of each email. Please read our Terms and Conditions and our statement of Responsibilities, Waiver and Release.Do you agree to the terms of these three documents?*YesNoBy submitting this registration you will be agreeing to the terms in these three documents, for yourself or on the behalf of the one you are registering for this event. It appears that you will not be able to complete the registration at this time. If you have concerns or questions regarding our terms for participation, we would be glad to have you contact us to discuss it. Select form of payment...*I will pay with my CREDIT CARD.I will pay with my PAYPAL account.I have made other payment arrangements with the Mediterra Office.Payment Method*PayPal CheckoutCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name
