Stage 1 of 3

Forename(s)
Surname
Address
Postcode
Telephone
Enter Parent/Guardian's email below if swimmer is under 18
Email Address
Date of Birth
Gender
Ethnicity
Emergency Contact Name
Emergency Contact Phone
Emergency Contact 2 Name
Emergency Contact 2 Phone
ASA Registration Number (if known)
Do you swim for another club?
Are you an amateur according to ASA laws?
Membership Type
Note: All payment of swim fees should be made by bank standing order or direct debit.
I/We Agree to Standing Order/Direct Debit Payments
Note: Typing your name into the swimmer or parent/guardian box below is the same as you physically "signing" the form
Signature of Swimmer (or guardian if swimmer under 18)
Security Image	Change Image
Enter Security Code Above

Note: Please check your details carefully. You can not change them once you move to the next page.