SECTION 1 (to be completed before first swim)

Name........................................................................................................

D.O.B..............................................

Address....................................................................................................

........................................................ …….. Post code …………………….

Tel.no:..............................................

E-mail..............................................

Are you happy to receive all club communications via e-mail? YES/NO

Swimming History

Club(s) with dates......................................................................................

Any recently achieved times.......................................................................

Please circle the categories that interest you

Competitive ~ Triathlon ~ Fitness ~ Stroke Development

SECTION 2 (to be completed on taking up membership)

I acknowledge that I have read the rules of Gloucester Masters Swimming Club and confirm my understanding and acceptance that such rules (as amended from time to time) shall govern my membership of the Club. I further acknowledge and accept the responsibilities of membership upon members as set out in these rules.

Signature ………………………………………… Date ……………………..

SECTION 3 - FOR OFFICIAL USE ONLY

Date of first swim.............................

Concession? .................................... Subscription due £ ......................

Paid (date)........................................ Signed .............................................