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Halliwick AST
Club Affiliation Form

Name of Club, School or Establishment:
Halliwick ASTRA:

We the undersigned, on behalf of the above Club, School or Establishment apply for membership of the Halliwick AST and agree to embrace its aims and objectives.
Date:
Chairperson or Headteacher
Name:
Address:
 
Postcode:
Tel:
email:
Signature:
Secretary or Honorary Secretary
Name:
Address:
 
Postcode:
Tel:
email:
Signature:
Club Information
Swim Venue:
Day and time:
No of swimmers:
No of other members:
(helpers, instructors)
Total membership:
Date Halliwick AST Insurance paid:
Extent to which the Halliwick Concept is used: Always | partially | never


Affiliation fee:

Clubs, Schools and Establishments should send this form and a cheque for £20.00 made payable to Halliwick AST, direct to the Association at the ADKC Centre address below:

Halliwick Association of Swimming Therapy
c/o ADKC Centre
Whitstable House
Silchester Road
London W10 6SB