LFB Member Registration Please complete and send the following form to register Lucky Fin Barracuda. (Personal information will not be used for purpose other than to register LFB mailing list, to inform practice schedule and to contact for emergency.) Please feel free to send email to the following address should you have difficulty completing the online form. NAME* Taro Lucky NAME in Japanese kana* ラッキー タロウ E-mail address* tarou_lucky@freeoloyy.jp Confirm E-mail address* tarou_lucky@freeoloyy.jp Phone number* 090-1111-8888 (Emergency) Phone* 03-2222-4444 Zip code 123-9876 Address* Police Park 402, Kameari 1-2, Katsushika-ku, Tokyo Sex* Male Female Date of birth 年 月 日 1980年08月31日 Swimming Experience* 選択して下さい 泳げない 泳げる(100mつづけて) 競技経験あり Finswimming Experience* 選択して下さい 未経験 初級者 中級者 上級者 Scuba Experience* 選択して下さい 未経験 10本未満 50本未満 100本未満 100本以上 ダイブマスター・インストラクター Freediving Experience* 選択して下さい 未経験 素潜り経験あり(水深5m以内) 素潜り経験あり(水深15m以内) フリーダイビング講習受講済み 深度競技経験あり Experience Detail Big Blue apnea academy King of freediving 2005 Constant 2nd AIDA 3stars certificate How do you know LFB?* インターネット 新聞・雑誌 大会会場 人・団体からの紹介 その他 Name of website, newspaper, magazine, competition, person, group or other detail Comment/Question Items of * must be completed. <Important> Safety control at Lucky Fin Barracuda practice (The Assumption of Risk Agreement) Lucky Fin Barracuda (hereafter, LFB) takes all possible measures of safety for our practice. However, 100% of safety can not be guaranteed for the underwater activity. The participants are responsible for their own safety. LFB or LFB staff are not responsible for participants' accident, injury, property damage, and incident of injuring other participants. LFB holds the power to force participants to leave the program when LFB or LFB staff judge that the participants' action to interrupt the safety of the practice. LFB is the non-profit organization, the limited capacity of whose staff might not be able to correspond to all participants' need. Do you agree above 'The Assumption of Risk Agreement'* No, I do not agree. Yes, I agree.