Brighton Swimming Club Membership Application Form
Please enter the details of the person applying to join the club below.
Email address *
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Town/City *
Your answer
Post Code *
Your answer
Primary Phone *
Your answer
Emergency Contact (Name and Number) *
Your answer
Emergency Contact 2 (Name and Number) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Sex *
Club Activities *
Please enter any medical conditions we should be aware of *
If none put N/A
Your answer
2nd Email
Your answer
If you are already an ASA member please enter your known name , registration number and the details of your present club
Your answer
If you are over 16 and in full time education please give brief details
Your answer
Signed *
Name of applicant or Parent /Guardian if applicant is under 16
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
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