Select Membership TypeNew member? *New membership to this clubTransferring my primary membership from another clubIf transferring, from what club?Membership CategoryAdministratorClub SwimmerCoachCompetitive SwimmerFriend of SwimmingLearn to SwimRecreational SwimmerNon-Voting Technical OfficerLifeVolunteerVolunteer CoachVoting Technical OfficerPersonal Details of MemberPrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Middle NameLast Name *Date of birth *Gender *MaleFemaleOtherRather not sayPlease select your ethnicityNew Zealand EuropeanOther EurpoeanMaoriSamoanCook Islands MaoriTonganNiueanTokelauanFijianOther Pacific PeoplesSoutheast AsianChineseIndianOther AsianMiddle EasternLatin AmericanAfricanOther EthnicityPrimary ContactPlease enter at least one primary contact (the Club would prefer two, but recognises this is not always possible. Please ensure that you update the club should primary contact details change in the future, thank you)PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Last Name *Street Address *Suburb *City *Postal Code *Phone 1 *Phone 2Email Address *Secondary ContactSecondary ContactAdd secondary contact?PrefixMr.Mrs.Ms.Mx.MissDr.Prof.First NameLast NameStreet AddressSuburbCityPostal CodePhone 1Phone 2Email AddressOther InformationPlease indicate any areas that may be of benefit to the club (For example: qualified IOT; director on boards; relevant work experience.)UpdatesFrom time to time the club, region and SNZ would like to circulate information to the membership. Please tick the box (es) if you wish to receive information on the following:General UpdatesSwimmersCoachingLearn to SwimAdministrationOfficialsMember DeclarationPlease read the declaration, check the box and submit.I have read and I consent to the Membership Declaration or if the member is under 18 yrs, I am the parent/guardian/caregiver of the applicant who is under 18 years of age. I have read and understood this application form and the applicant’s membership declaration (over page). I understand the form and the declaration and I consent to the applicant’s application for membership on this basis. I also consent to the use of my/their personal information in accordance with clauses 4 and 5 of the membership declaration. No information from this form is stored on server, but is delivered in an email to the following recipients: admin@raptors.nz, treasurer@raptors.nz, racesec@raptors.nz, Membership (using personal email).Register