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                       Application No._____________

 

                                                                                                                                Date of Acceptance __________

                                                APPLICATION FOR MEMBERSHIP

                                                   (Please print and complete both sections)

DATE………………………..

 

Dear CLUB SECRETARY,

I hereby apply for swimming/associate membership of BURNTISLAND A.S.C. for my child/myself.  I understand that I will be informed if and when a place becomes available.  I also understand that all members on joining the Club shall be deemed to accept the terms of the constitution and any such Byelaws as may be published.

 

NAME……………………………                             SWIMMER/NON-SWIMMER/ASSOCIATE

                                                                                     (please delete as appropriate)

 

Address …………………………..                           Date of birth …………………………….

 

…………………………………….

 

Post Code ………………………..                            Telephone no. ……………………………………..

                                                                                Mobile No …………………………………………..

E-mail address ………………………………………

 

PLEASE INDICATE IN CONFIDENCE, WITH RESPECT TO YOUR CHILD, ANY MEDICAL CONDITION OF WHICH THE COMMITTEE SHOULD BE AWARE.

 

………………………………………………………………………………………………………

 

………………………………………………………………………………………………………

 

Yours sincerely

 

……………………………………………………(Parent/Guardian/Applicant)

 

 

                                BURNTISLAND ASC                                           FOR OFFICAL USE  App. No …………

 

NAME ………………………………………                              SWIMMER/NON-SWIMMER/ASSOCIATE

 

Address ………………………………………                           Date of Birth …………………………

 

…………………………………………

 

Post Code ……………………………………                           Telephone No………………………..

                                                                                                Mobile No ……………………………

E-mail address ……………………………………………….

 

PLEASE INDICATE IN CONFIDENCE, WITH RESPECT TO YOUR CHILD, ANY MEDICAL CONDITION OF WHICH THE COMMITTEE SHOULD BE AWARE.