MIME-Version: 1.0 Content-Location: file:///C:/9E74CAAD/ApplicationForm.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" NEW MEMBERS ONLY

NEW MEMBERS ONLY &n= bsp; Form 3

Application Form for Membership of Swim I= reland

 (Excluding Learn-to-Swim)

Date of Birth must be completed by a= ll Competitive Members

 

PLEASE USE BLOCK CAPITALS<= /b>

 

CLUB:_______= ____________________________________________________________

 

First Name:­&sh= y;­­­________________________

 
 
Surname:_______________________________= ______

 &= nbsp;           &nbs= p;               Male        &= nbsp; Female

 
 

 
 
Gender:             &n= bsp;            = ;            &n= bsp;              =  Date of Birth:_________________________

 &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;            &= nbsp;           &nbs= p;                =              (Compulsory for all Competitors)

 

Phone [H]___= _____________Mobile:_________________Email:_______________________= __

 

Address:_____________________________________________________= ____________



Category of Membership

 

        COMPETITOR  ONLY        &= nbsp;           &nbs= p;   Tick Discipline √

Swimming

Water Polo

Masters

Diving

Synchronised

 

 

 

 

 

        =                   =             &nb= sp;           Other Categories  Please Tick  √

Non – Competitor/

Recreational Swimmer

Chairperson/

President

Club Secretary =

Treasurer

Coach

Teacher

 

 

 

 

 

 

Associate

Member

(ASTCI) <= o:p>

Committee

Member

Team

Manager

Children’s

Officer

Designated

Person

Official/

Other (Specify)=

 

 

 

 

 

 

 

         Please list all other Clubs/Youth Groups you have been involved with= :

1.

2.

3.

4.

5.

6.

Have you ever been asked to leave a sporting organisation:     Yes/No

If yes, please explain on a separate sheet.=

I agree to abide by the rules and regulations of= Swim Ireland and those of the club= named on this form.  I accept that my membership can be withdrawn, if I am found to be in breach of such rules.

 

Applic= ant's Signature:         =             &nb= sp;                  =                 &= nbsp;    Dated: _________        =      

(If the Application is for an under 18 then the parent must also sign)

 

Parent= 's Signature:             =             &nb= sp;            =             &nb= sp;

 

All co= mpleted Applications must be signed by the Club Secretary to confirm that the above named has been accepted as a member of their club and is actively involved;=

&nb= sp;          

Signat= ure:                =             &nb= sp;            =             &nb= sp;            =                

Club Secretary=