Personal Information

Name:

Email Address:

Home Phone Number:

Mobile Phone Number:

Date of Birth: (DD/MM/YYYY)

Address:

Background Information

Are you a current registered member of Swim Ireland? Yes No
Reg No. ( If Yes to previous question )

Are you transfering from a different swimming club? Yes No
Reason for Leaving previous club:

Swimming Interest: (Please tick one or more of the following)
Keep Fit Competitions and Galas Triathelons
Open water swimming Long distance swimming Social

Membership Information

As a member of the NAC Masters Swimming Club do you agree to abide by the club rules and the club's constitution?

Yes No