Membership

Full Name of First Member*

First Last

Type of Membership*

Add Member No 2 ?*

NO
YES

Full Name of Second Member*

First Last

Type of Membership*

Add Member No 3 ?*

NO
YES

Full Name of Third Member*

First Last

Type of Membership*

Add Member No 4 ?*

NO
YES

Full Name of Fourth Member*

First Last

Type of Membership*

Add Member No 5 ?*

NO
YES

Full Name of Fifth Member*

First Last

Type of Membership*

Add Member No 6*

NO
YES

Full Name of Sixth Member*

First Last

Type of Membership*

Contact Information Changes Since last Renewal ?*

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Home Phone*

Mobile Phone*

Medical Information Changes Since last Renewal ?*

If you answer Yes to this question we will contact you to discuss the medical Information in person.

Contact Email Address*

Please provide a valid email address which will be used by UASC or ASA Membership to contact you

Enter Email Confirm Email

Mailing Group Consent*

I give permission to be invited to the UASC Mailing Groups

Photo / Video Permission Consent*

I consent for photos / videos to be taken by UASC and used for training, promotional, and celebration of achievement purposes in line with our Data Protection Policy.

Data Processing Consent*

I confirm that i have authority to give consent on behalf of the names listed within this application. I consent to all data submitted can be collected, stored and used to process this membership application to both UASC & ASA membership, in line with our Data Protection Policy.

Total

£ 0.00

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Card Number Expiration Date Security Code Cardholder Name

Type of Membership	Amount
1^stswimming member in the family	£47
2^ndswimming member in the family	£42
Any subsequent swimming members	£36
Non Swimming members	£12

Membership

Membership Form