UNCW Swimming and Diving Information Form
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Personal Information
1.
Name:
*
2.
Gender
*
--Please Select--
Male
Female
3.
Address
*
Street
City/State/Zip
4.
Parents Name and Occupation
Mother's Name
Occupation
Father's Name
Occupation
5.
Phone Numbers
Home Phone:
Cell Phone:
6.
Email Address
7.
Birthdate
*
The value must be less than or equal to 12/31/2010.
mm/dd/yyyy
8.
Height/Weight
*
Height
Weight