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Halliwick AST
UK Personal Affiliation Form

I the undersigned apply for membership of the Halliwick AST, and agree to support its aims and objectives.
Name:
Address:
 
 
 
Postcode:
Tel:
email:
Date:
Signature:

I would like to be put in touch with a Halliwick AST Club in my area: YES | NO

Please enclose with the form a cheque or postal order for £15.00 made payable to Halliwick AST and send to:

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