Affiliation Package (Page 4 of 4) in pdf

Affiliation Package Page 4

2016-2017 Annual

Region

Association

A liation Package

Application

On behalf of the members of the ..................................................................................... Swimming Region,

I acknowledge that I have read, understood, and agree to the declaration and conditions of

membership. I warrant that all information provided is true and correct.

We hereby apply for Membership to Swimming WA for the 2016/2017 season.

Name

Position

Signature

Date

THE REGION ASSOCIATION AFFILIATION FEE IS DUE BY 1ST JULY 2016.

Please complete the section above and return it to;

Shannon Fisher

Membership and Accounts O cer

Email: .au

Post: PO Box 205

Leederville WA 6903

Conﬁrmations must be completed and returned with the a liations fees and forms.

Should you have any questions about this issue or have concerns about the level of compliance of

your Club with these Policies, please do not hesitate to contact me in the o ce.

Thank you for your continued support of Swimming in Western Australia

Sincerely,

Darren Beazley

Chief Executive O cer

Swimming

Club A liation Package 2016/17 Season

Affiliation Package Page 4