1. Applicant Details

Before submitting your application for selection as an Instructor or Mentor for the Eastern Region Intermediate Lifeguard Pilot Programme, please ensure you have read the selection process.

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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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* 7. Date of Birth

DD/MM/YYYY

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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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