MASTERS SWIMMING AUSTRALIA 2nd CLAIM MEMBERSHIP REQUEST FORM

MASTERS SWIMMING AUSTRALIA

2nd CLAIM MEMBERSHIP REQUEST FORM
To be completed by a current (Financial and Active) Masters Swimming Australia member wishing to claim membership of a second club. NOTE: Your primary club membership must be paid and activated prior to submitting a 2nd claim request.
Your name *

First Name Last Name
Your Email *
example@example.com
Primary Club Name *
Full name of club you are first claim member with.
MSA Member Number *
Date of Birth *
Phone Number *

Area Code (if use mobile put country code here) Phone Number
Renewing an existing 2nd claim membership? *

YES NO
If YES, name of club is
Full name of existing 2nd claim club
If NO, name of new 2nd claim club is
Full name of new club
If NO, what is the reason why you want to join a new second claim club
This assists with new second claim club approvals
Do you require this second claim profile to enter an upcoming meet *

YES NO
If yes please provide event name and closing date
Note: Your 2nd claim membership CAN NOT be used until you receive email notification from MSA AND you have paid any required Branch/Club fee AND your membership has been activated by the 2nd claim club.

Once you have been activated you will be sent a Username and will need to do a password retrieval with this Usename to set your unique password for this profile that is ONLY to be used in relation to your 2nd claim membership. Only your membership number remains the same.

Note* This process can take some time. It is recommended you contact the 2nd claim club and let them know you are placing a request for a 2nd claim membership.
Date request made *

Day Month Year
Put full year eg 2017 Date Picker Icon
OFFICE USE ONLY:
Date received
Date processed
Should be Empty: