OZFIN TREASURER

Kathy Jones

5 Heathcombe Crescent

Sandy Bay Tasmania 7005

Send this form to:

MEMBERSHIP FORM – OZFIN/AUF MEMBERSHIP

Name ……………………………………………………………………………………………………

Club …………………………………………………………………………………………………….

Mailing Address: ………………………………………………………………………………………..

………………………………………………………………………………………

State: ………………………..Post code:……………… Date of Birth / /

Phone: (……)……………………. Home (……)………………………..Work ………………….(Mob)

Fax: (……)…………………… Email: ……………………… Occupation: ………………………

Australian Citizen? Y / N Nationality if not Australian ………………. ……….. Gender M / F

(NOTE: members must be an Australian citizen to claim records or gain selection on an Australian team)

SCUBA QUALIFICATIONS: …………………………………CERTIFICATE NO………………..

CURRENT SPORTING QUALIFICATIONS: (e.g. Official, Coach, Pool Lifeguard, First Aid, other)

………………………………………………………………………………………………………….

…………………………………………………………………………………………………………..

CONDITIONS OF MEMBERSHIP AND WAIVER

I …………………. ………acknowledge that Fin Swimming can be a dangerous sport and agree to participate at my own risk. I also acknowledge that I am responsible for my own health and safety and hereby absolve the OZFIN executive, and executive members of affiliated clubs from any financial responsibility or compensation that may arise from my participation. I further agree to inform coaches and club officials of any illness that may prevent me participating in training or competition and absolve them from all responsibility. I agree to abide by the rules and regulations of OZFIN.

OZFIN MEMBERSHIP:

Competitor $ 50 (includes AUF fee)

or Non-Competitor $ 40

State/Club Levy $ (as set by individual clubs and states)

TOTAL

Please find enclosed cheque/money order to the value of $

Signature……………………………. Date ……./……../……….

(this signature designates agreement for the above conditions of membership, memberships is not valid with signature).

Club Received / /

OZFIN Received / /

AUF Received / / Membership number ……………