Wufoo

Name * First Last
Email *
Phone Number *
Are you interested in Triathlon or openwater swimming? *
How can we help you? Please give a brief description of your main aim for the service you want. *
What date suits you best to come in? * MM / DD / YYYY
What time suits you best to come in? * HH : MM : SS AM/PM
Do you suffer with any health problems or have a history of any health problems? Please tick the appropriate box below. *
No Back pain Epilepsy Heart Condition Respiratory Condition Diabetes Hypertension Dizziness Chest Pain Dizziness Other
Before attending, please ensure that you are fit enough to be able to participate in the services we provide. If you are at all unsure, please consult your Doctor prior to making this booking. If you attend and your assessor does not believe you are in a suitable state of health you will be informed of this and your booking will not be fully refunded.

Please list any other medical conditions of note. If you ticked yes to any of the options above, you will need to get permission from your GP to partake in the LeMonde Power Tap classes and Swim Analysis.
Base2Race is located in -->

Unit 46
Fashion city
Ballymount
Dublin 24
(take exit 10 from M50 and we are behind the Honda garage)

https://www.google.com/maps/place/Base+2+Race+LTD/@53.308159,-6.3552247,17z/data=!3m1!4b1!4m2!3m1!1s0x0:0x88445b0b0d30e400
Have you owned a wetsuit before, if so what type
Do Not Fill This Out