MWM Session Registration Form This form allows applicants to register for upcoming MWM lesson sessions. Fields marked with an * are required Name* First Last Name of registrantAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Address of registrantEmail* Email address of registrantPhone*Phone number of registrantDate of Birth* MM DD YYYY Name of Emergency Contact* First Last We have never had any problems, but just in case, we'd like the name of someone to call if we encounter a problem.Phone for Emergency Contact*We have never had any problems, but just in case, we'd like the phone number of someone to call if we encounter a problem.Session registration*We are now accepting registrations for our 2020 sessions. Start of the new year getting in the swim of things - what a great resolution!Yes: Register me for the January, 2020 3 open swim sessions for $20 at St. Ann at 2450 W NorthYes: Register me for the 7-lesson session from Sun. Feb.2-Sun. Mar. 15 at Pulaski County PoolKeep my information for a subsequent sessionLevel of swim instruction sought*This allows the selection of the specific level desired for the swimmer. See the description of the levels at http://makingwavesmilwaukee.org/services/ Level 1 - True BeginnerLevel 2 - Intermediate BeginnerLevel 3 - Advanced Beginner7-weeks of swim lessons*Making Waves Milwaukee offers the 7 weeks of swim lessons for $50. For those unable to pay, we offer scholarships.Pay for 7-lesson sessionPay for 3-session open swimRequest scholarshipPhoto Use Waiver*As a new organization, we would like to take photos including our participants during instruction to share on our website and social media outlets to promote our program.You may use photos with me in them.Please do not use photos of me.CommentsPlease let us know if you have anything particular about yourself that we should know about in regards to swimming.Gender information for GrantorFemaleMaleOtherPrefer not to respondOne of our grantors requested we collect gender information for our participants. Please provide this for reporting purposes.Race/Ethnicity information for GrantorAmerican Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiianother Pacific IslanderWhiteOtherPrefer not to respondOne of our grantors requested we collect race/ethnicity information for our participants. Please provide this for reporting purposes.