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HAWAIIAN SWIMMING
CLUB MEMBERSHIP APPLICATION
Top of Form
Date: ________________________ PRIVATE "" MACROBUTTON HTMLDirect Full Year PRIVATE "" MACROBUTTON HTMLDirect Seasonal
Bottom of Form
(Club Name) ______________________________________ hereby applies for membership in Hawaiian Swimming, USA Swimming for the ________ calendar year. The current annual membership dues of $______ is enclosed. When accepted as a Club Member, we agree to abide by the bylaws, rules, regulations, policies, and procedures of Hawaiian Swimming and USA Swimming. We will also respect, abide by, and enforce all decisions of Hawaiian Swimming and USA Swimming.
Signed: _______________________________ _________________________________
Club President Head Coach
CLUB CODE (letters only maximum 4): ____________
(For renewals only) Is this a change from last year? Yes _____ No ______
Identify the individual and address of club official whose name will be sent to USA Swimming. All mail from headquarters will be sent to this person at the address given.
Name and position ________________________________
Address ________________________________________
_________________________________________
Telephone No. (Home) ______________ (Work) _______________
Club e-mail address ________________________________________
On the attached sheets (Club Roster), please list the name, address, and telephone numbers for the positions listed. Please include all coaches, aides, helpers, etc. if they are on deck with the head coach during practice or at swim meets. They all should be USA Swimming Members, and all of the following certifications (CPR, Safety Training (will include First Aid), Education Req., Background Checks, and APT) must be up to date.
Notes:
Re-registering clubs: Application and payment must be received by December 15 for registration to be effective prior to the start of the next calendar year.
New clubs: Application and payment may be submitted at any time.
Mail to: Gwenn Tomiyoshi, Registration/Membership Coordinator
Hawaiian Swimming
171 G Ainaola Dr.
Hilo, Hawaii 96720
(808) 959-0608
Revised April 12, 2015
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