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.

Your primary club membership must be paid prior to submitting a 2nd claim request.
Your name*

First NameLast Name
Your Email*
example@example.com
Name of your Primary CLUB *
Your FIRST CLAIM CLUB name
MSA Member Number*
Date of Birth*
dd/mm/yyyy
Phone Number*

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

YESNO
Name of your 2nd Claim CLUB*
Your 2nd CLAIM CLUB name
If this is a NEW 2nd CLAIM CLUB request please say why you would like to join this club
Do you require this second claim profile to enter an upcoming meet*

YESNO
If yes please provide the name of the Meet
Name
If yes please provide Meet closing date
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.

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 form submitted
dd/mm/yyyy
OFFICE USE ONLY:
Date received
Date processed
Should be Empty: