Carnival Nomination Form

Date of carnival:

Choose the events you wish to enter

Age Events:

Freestyle:25m50m100m200m 400m 800m 1500m

Backstroke:25m50m100m200m

Breaststroke:25m50m100m200m

Butterfly:25m50m100m200m

Individual Medlay:100m200m400m

Open Events:

Freestyle:25m50m100m200m 400m 800m 1500m

Backstroke:25m50m100m200m

Breaststroke:25m50m100m200m

Butterfly:25m50m100m200m

Individual Medlay:100m200m400m

Payment: We are only accepting direct deposit into the Western Aquatics account.
Full Payment must be made before submitting this form

Bank: Bendigo Bank
Account Name: Western Aquatics INC
BSB: 633 000
Account: 150 252 807
Please Reference your surname and carnival name when making payment.