LGBT Masters Aquatics Club

Brighton Membership Application Form

If you have any problems completing this form please send us a message through our Facebook page.

Membership Start Date (MM-DD-YYYY) *
Membership Start Date (MM-DD-YYYY)
When would you like your subscription to start from? Please note that your membership will not start until payment is received so use this box to designate when we are likely to receive your payment.
Which disciplines are you interest in? *
Name *
Name
Address *
Address
Date of Birth (MM-DD-YYYY) *
Date of Birth (MM-DD-YYYY)
We ask this question on behalf of the ASA, you are not required to answer.
We ask this question on behalf of the ASA, you are not required to answer.
Emergency Contact Name *
Emergency Contact Name
If known
ASA Category 1 membership is for members who do not compete in any discipline in open competition. ASA Category 2 membership is for all members who compete in any discipline in open competitions. ASA Category 3 membership is for all members who are not in categories one or two including, but not being limited to, any persons who have voting rights in their club by virtue of being a parent of, or a person with parental responsibility for, a member in categories one or two; administrators; associate members; coaches; helpers; honorary members; life members; officers; qualified officials of any discipline; patrons; teachers; temporary members; vice-presidents and verifiers or tutors of the Association’s educational certificates.
ASA Consent *
I confirm that I am a competitive member of Out to Swim. I confirm that I will submit myself to official Doping Control at any time when requested. I agree to abide by the rules of the ASA and British Swimming. I understand that by submitting this form, I am consenting to receiving information about ASA / British Swimming initiatives from the ASA / British Swimming and their commercial partners by post, email, SMS/MMS, on-line or phone unless I indicate otherwise as below.
Would you like British Swimming/the ASA to send you details of their products and services? *
Would you like British Swimming/the ASA to send you details of events? *
Would you like British Swimming/the ASA to send you details from British Swimming/the ASA's commercial partners? *
If you hide your details they will not be visible on the Rankings Database which may affect your ability to enter events. Event organisers may in these cases require proof of age and/or of eligibility to enter and you should contact the particular organiser to check.
I authorise the club to inform the relevant members of the club of any physical, medical or mental condition disclosed to ensure my safety and well being as well as that of other members of the club. Only those who need to know will be informed. I acknowledge that it is my decision whether to inform other members of the club. *
I agree to abide by the rules of the club *