Affiliation Package Page 2

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2016-2017 Annual
Region
Association
A liation Package
Treasurer
Name: (Mr / Mrs / Ms / Miss)
Email
Phone
Swimming WA Membership Number
Working with Children Check Clearance No.
Expiry
Registrar
Name: (Mr / Mrs / Ms / Miss)
Email
Phone
Swimming WA Membership Number
Working with Children Check Clearance No.
Expiry
Any other committee position
Name: (Mr / Mrs / Ms / Miss)
Email
Phone
Swimming WA Membership Number
Working with Children Check Clearance No.
Expiry
Clubs in Region (please list all SWA a liated clubs which reside in your regions boundaries)
33
Swimming
WA
Club A liation Package 2016/17 Season

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