Nomination Form

(For Henley and Grange Swimmers only)

Nominations

The Swimming SA nominations process is a manual one which requires extra workload for our nominations officer. Due to this the club requests that all nominations and payments be submitted a week prior to the Swimming SA nominations due date.

Before Submission

* Please confirm all competition details before submitting the following form. All information including meet details, prices and qualification times can be confirmed via the above links.

* Please make payment arrangements of competition costs

Payments will be accepted via the following methods:

1. EFT to the following accout: (please retain a copy of your receipt number for your nomination form)

Account: Henley & Grange Swimmin Club Nominations Account
BSB: 105 074
Account Numner: 023998940
Reference: Swimmer’ s surname and the compition for which the payment is intended

2. Cheque, made payable to “Henley and Grange Swim Club Nominations”

3. Cash, please ensure the correnct amount is given to either the nominations officer or your coach.

Download Printed Version: Nominations Form PDF

Swimmer's Name*
First Last
Date of Birth*

Day
Month
Year
Meet Name*
Date of Meet*

Day
Month
Year
Event No.
Age Group
Distance
Stroke
Entry Time
Date/Meet Achieved
Event No.
Age Group
Distance
Stroke
Entry Time
Date/Meet Achieved
Event No.
Age Group
Distance
Stroke
Entry Time
Date/Meet Achieved
Event No.
Age Group
Distance
Stroke
Entry Time
Date/Meet Achieved
Event No.
Age Group
Distance
Stroke
Entry Time
Date/Meet Achieved
Event No.
Age Group
Distance
Stroke
Entry Time
Date/Meet Achieved
Event No.
Age Group
Distance
Stroke
Entry Time
Date/Meet Achieved
Event No.
Age Group
Distance
Stroke
Entry Time
Date/Meet Achieved
Payment Type*
Payment Details*
Payment Total EFT Receipt No.
Contact Email*

A copy of this form will be emailed to you
Phone