Application Form

APPLICATION FOR MEMBERSHIP 2009.

Family Surname(s):

OFFICIAL USE ONLY

Address:


	Postcode:
e-mail:	Telephone No:
Emergency Contact No.

Individual Member's Details:
First Name	Family or last name	Date of Birth		Adult	OFFICIAL USE ONLY
First Name	Family or last name	Under 10	10 - 18	Adult	OFFICIAL USE ONLY
1
2
3
4
5
6
7

Note: Children under 10 years must be accompanied by an adult at all times.

Family membership fee is £27.00 which must be enclosed with this form. Please make cheques payable to 'Polehampton Swimming Association'.

Donations of any amount are always very welcome. Please add to your membership payment, thank you.

Send or take this form to:
Polehampton Junior School, Kibblewhite Crescent, Twyford, Reading, RG10 9AX.

Or to:
Jane Clark, 16, Kibblewhite Crescent, Twyford, Reading, RG10 9AX.

Method of payment: CASH_____CHEQUE_____PLEASE PAY BY CHEQUE IF POSSIBLE

Amount paid Membership_____ Donation_____ Total_____

If you are a U.K. tax payer please tick here _______, this enables us to reclaim your tax as gift aid.

Membership cards will be available for collection at the pool only.

Polehampton Swimming Association.

POOL SUPERVISION.

The association is entirely dependent on voluntary pool-side help by members. Without the required level of help a session will be cancelled. If you can help, or require further information, please contact Sharon Searle on 0118 934 2040 if you can help in the afternoon or Lesley Jarvis on 0118 934 2374 if you can help in the evening.

Alternatively, if you are available for specific sessions, please complete the following.

Name____________________________Telephone Number____________________

I will help on a regular Weekly______Monthly______BiWeekly______ Basis.

Term Time (9^th May to 5^th September)					Holiday Time (25^th to 29^th May and 21^stJuly to 1^st September)
Time	***	Wed	Thu	###	Time	***	Wed	Thu	###
10.00-12.00a.m.	Saturdays only				10.00-12.00a.m.	Saturdays only
4.00-5.00p.m.					2.00-3.00p.m.
5.00-6.00p.m.					3.00-4.00p.m.
7.00-8.00p.m.					7.00-8.00p.m.

*** Monday for 7.00 - 8.00p.m., Tuesday for all other sessions.
### Saturday for 10.00 - 12.00a.m., Friday for all other sessions.

If you can help on a specific day, or require further information, please contact:

Sharon Searle	on 0118 934 2040	for afternoon sessions.
Lesley Jarvis	on 0118 934 2374	for evening sessions.