EmailMe Form - Update Club Committee Form

What club are you from? *

What area does your club belong to? *

Club Mailing Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Club Delivery Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Our AGM is to be /was conducted on

MM / YY

Public Contact Email Address *

This address will be published on the Swimming NSW website so the public can contact you with inquiries.

Communications Email Address *

This is the email address Swimming NSW will primarily use to communicate with your club.

Club Committee Member Information

Secretary

Name *

First Last

Membership Number *

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number *

Number *

Alternate Contact Number

Number

Email *

President

Name *

First Last

Membership Number *

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number *

Number *

Alternate Contact Number

Number

Email *

Vice President

Name *

First Last

Membership Number *

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number *

Number *

Alternate Contact Number

Number

Email *

Treasurer

Name *

First Last

Membership Number *

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number *

Number *

Alternate Contact Number

Number

Email *

Registrar

Name *

First Last

Membership Number *

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number *

Number *

Alternate Contact Number

Number

Email *

Race Secretary

Name *

First Last

Membership Number *

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number *

Number *

Alternate Contact Number

Number

Email *

Member Protection Information Officer (MPIO)

An MPIO is responsible for providing information about a person’s rights, responsibilities and options to an individual making a complaint or raising a concern. This role can be looked after by a committee member who holds another position in your club.

Name *

First Last

Membership Number *

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number *

Number *

Alternate Contact Number

Number

Email *

This committee member has completed the Play By the Rules MPIO training (tick to confirm).

To complete MPIO training go to:
https://www.playbytherules.net.au/online-courses/mpio-online-course

Complaints Handler (Optional)

Name

First Last

Membership Number

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number

Number

Email

Head Coach (Optional)

Name

First Last

Membership Number

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number

Number

Email

ASCTA Membership Number

Other Committee Position (Optional)

Please use this section if you'd like to add the contact information of another committee member that we should know about.

Committee Position Held

Name

First Last

Membership Number

Membership Number is the 6- or 7-digit number issued to you upon registration.

Preferred Contact Number

Number

Email

*

I confirm that as positions change throughout the year, ClubLANE will be updated to reflect this. The Committee members allocated in ClubLANE will be used for communication from Swimming NSW.

*

All committee members are registered financial members.

Declaration

I, the authorised officer of the club declare that to the best of my knowledge and belief the statements set forth herein are true. Agreeing to this declaration does not bind me on behalf of other club officers. *

Clear

Using your mouse cursor, sign above.

Name *

First Last

*

Committee Position Held

Date *

DD / MM / YYYY