Before submitting your application for selection as an Head instructor, Instructor or Mentor for this season's Intermediate Lifeguard School, please ensure you have read the selection process and your club are aware of your application.

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* 1. Please indicate what position you wish to apply for

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* 2. First Name

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* 3. Last Name

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* 4. SLSNZ Membership Number

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* 5. Club

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* 6. Date of Birth

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* 7. Age

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* 8. Gender

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* 9. Email Address

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* 10. Contact number (cell phone)

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