Membership Form
Swimmers Details
First Name (Swimmer) *
Your answer
Last Name (Swimmer) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Email *
Your answer
House Number / Name *
Your answer
Address
Your answer
Postcode *
Your answer
Primary Emergency Contact *
Please give your name and relationship to the swimmer
Your answer
Primary Emergency Contact Number *
Mobile number preferred.
Your answer
Secondary Emergency Contact *
Please give your name and relationship to the swimmer
Your answer
Secondary Emergency Contact Number *
Please provide at least one mobile number
Your answer
Is this the only club the swimmer is a member of? *
If you are a member of another club, please state the name of the club.
Your answer
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