Application for Membership with the Preston Amateur Swimming & Life Saving Club Inc.

I wish to apply for membership with the Club, and I agree to abide by the rules of the Club, rules of Swimming Victoria Inc. and the rules of FINA, for the time being in force.

FIRST NAME:	SURNAME:
ADDRESS:
		POSTCODE:
TELEPHONE No:	MALE / FEMALE
DATE OF BIRTH:	(circle whichever is applicable)

ARE YOU CURRENTLY A MEMBER OF ANOTHER SWIMMING CLUB?

If yes please list club: ___________________________________

WHAT IS YOUR SWIMMING VICTORIA REGISTRATION NUMBER? ___________________________

HAVE YOU COMPLETED A TRANSFER FORM? YES/NO

(circle whichever is applicable)

PARENTS FIRST NAME

FATHER: __________________________

MOTHER: __________________________

(For members under 16 years)

SIGNED: __________________________

(By the swimmer if over 16, or by Parent if under 16)

PLEASE CIRCLE THE SWIM STROKES YOU CAN DO, AND LIST THE TIMES FOR EACH STROKE IF KNOWN

FREESTYLE (crawl) _______ 50M _______100M

BREAST STROKE _______ 50M _______100M

BACK STROKE _______ 50M _______100M

BUTTERFLY _______ 50M _______100M

List any swimming experience you have had, competitions you have entered, learn to swim classes you have completed.

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