LGBT Masters Aquatics Club

Swiss Cottage 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)
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 Consent *
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 *