Brighton Swimming Club Membership Application Form
Please enter the details of the person applying to join the club below.
Email address *
First Name *
Last Name *
Address *
Town/City *
Post Code *
Primary Phone *
Emergency Contact (Name and Number) *
Emergency Contact 2 (Name and Number) *
Date of Birth *
MM
/
DD
/
YYYY
Sex *
Club Activities *
Please enter any medical conditions we should be aware of *
If none put N/A
2nd Email
If you are already an ASA member please enter your known name , registration number and the details of your present club
If you are over 16 and in full time education please give brief details
Signed *
Name of applicant or Parent /Guardian if applicant is under 16. Please note we will not retain any of the information, unless the application results in a completed membership.
A copy of your responses will be emailed to the address you provided.
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