Birmingham Adults Entry

First Name

Last Name

Comfirm Email

Contact Number

Emergency Contact Number

Date of Birth

Fundraising Target (£75 min, start your fundraising whenever you like!)

Distance

Estimated Swim Time (Minutes)

Select your Charity

Take part as a team?
Select Yes if you would like to take part as a team of 2, 3 or 4 friends

Team Name
This must match other team members Team Name exactly

Upload a picture for your fundraising page (Jpg Only)(5mb Max)

Commentator Info (Max 100 Characters)
This will be announced as you cross the finish line

Characters remaining: 100

Why do you want to take part and raise money?
This will be displayed on your fundraising page

By ticking this box you accept our Terms & Conditions.

Please take a moment to check everything before you submit, as any changes to your page can only be made by getting in touch with our team.

Distance	Swim	Bike	Run
Fun	200m	12.5km	2.5km
Super Sprint	200m	12.5km	2.5km
Sprint	400m	25km	5km