Learn to Surf – Register Here Name* First Last Are you Male or Female ?*MaleFemaleDate of Birth* Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Mobile*Email* NewsletterWe need your email to confirm your registration but we also send out an occasional newsletter with extra hints and tips, specials offers and updates. Yes. Add me to your mailing listEmergency Contact Person*Emergency Phone*Please list any medical conditions our instrcutors need to be aware ofe.g. asthma, allergies, injuries.Swimming Ability*Please let us know your swimming ability. You can still participate if you can't swim 50 m but we need to be aware of that.I CAN swim 50mI CAN'T swim 50mHow did you hear about us?*Saw the van or signsFriends / FamilySurf shopBrochure at backpackersRadioWebsiteOtherLesson TimeIf you've made a booking already put your class date and time here.Package*1 lesson - $802 lessons - $1204 lessons - $200Private - $1301 lesson 14yrs or under $50Payment*Cheques to Professional Surf Coaching Ltd. Bank acc 03 1599 0101039 00. Upon submitting you'll be directed to payment options.cash / chequeinternet bankingcredit card via pay palgift voucherDisclaimerThe participant accepts that the sport of Surfing and Bodyboarding contain an element of risk. The participant accepts that in the event of injury or death Professional Surf Coaching Ltd and its instructors will not be held liable. The participant agrees to follow all directions given by the instructors. Professional Surf Coaching Ltd accepts no responsibility for theft or damage to property belonging to the participantView our Terms & Conditions →Do you accept the above disclaimer and agree to our Terms and Conditions?* YesComments This iframe contains the logic required to handle Ajax powered Gravity Forms.