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FLOATATION DEVICE APPLICATION
Event Name *
- choose option -
Canberra MS Mega Swim
Casey MS Mega Swim
Fitzroy MS Mega Swim
Frankston MS Mega Swim
Hobart MS Mega Swim
Launceston MS Mega Swim
Melbourne MS Mega Swim
Mildura MS Mega Swim
Monash MS Mega Swim
Shepparton MS Mega Swim
Sydney MS Mega Swim
Wollongong MS Mega Swim
Team Name
First Name *
Last Name *
Email Address *
Phone Number *
Reason for use of a Floatation Device *
- choose option -
I live with MS
I live with a disability
I have an existing injury
I declare that information provide above is true and correct *
SUBMIT