2022 USA Athlete Membership

2022 USA Athlete Membership
Which Membership are you registering for*
LAST NAME*
LEGAL FIRST NAME*
MIDDLE NAME
PREFERRED NAME
DATE OF BIRTH*

MonthDayYear
Date
AGE
SEX*
ARE YOU A US. CITIZEN

YESNO
CLUB CODE*
Enter UN if unattached
NAME OF CLUB YOU REPRESENT*
if your not affiliated with a club enter Unattached
NOTE: If you are 18 years of age or older, you are required to abide by to the Minor Athlete Abuse Prevention Policy. In addition, in order to be a member in good standing, you must complete the Athlete Protection Training. The training can be accessed at www.usaswimming.org/apt
GUARDIAN #1 LAST NAME
GUARDIAN #1FIRST NAME
GUARDIAN #2 LAST NAME
GUARDIAN #2 FIRST NAME
MAILING ADDRESS*
CITY*
STATE*
ZIP CODE*
Phone Number

Area CodePhone Number
FAMILY EMAIL ADDRESS
example@example.com
MEMBERS EMAIL ADDRESS*
example@example.com
ARE YOU A MEMBER OF ANOTHER FINA FEDERATION

YES (IF YES, WHICH FEDERATION)NO
FINA FEDERATION
HAVE YOU REPRESENTED THAT FEDERATION AT INTERNATIONAL COMPETITION

YESNO
DISABILITY: OPTIONAL

A.Legally Blind or Visually ImpairedB.Deaf or Hard of HearingC.Physical Disability such as amputation, cerebral palsy, dwarfism,spinal injury, mobility,impairmentD.Cognitive, Disability such as severe learning disorder, autism
RACE AND ETHNICITY (You may check up to two choices):

Q. Black or African AmericanR. AsianS. WhiteT. Hispanic or LatinoU. American Indian & Alaska NativeV. Some Other RaceW. Native Hawaiian & Other Pacific Islander
HIGH SCHOOL STUDENTS YEAR OF GRADUATION
YEAR LAST REGISTERED WITH USA Swimming
YEAR OF GRADUATION
IF YOU REGISTERED WITH A DIFFERENT USA SWIMMING CLUB IN 2019, ENTER THAT CLUB CODE AND LSC CODE
ENTER DATE OF YOUR LAST COMPETITION REPRESENTING THAT CLUB:
APPROPRIATE PAPERWORK SHOWING LSC QUALIFICATIONS FOR THIS OUTREACH REGISTRATION MUST BE ATTACHED TO THIS FORM IN ORDER TO PROPERLY REGISTER THIS ATHLETE

Outreach Registration Qualifications

Please provide of one of the following: Redacted copy of Federal Tax return showing income below Federal Reduced School Lunch income Eligibility guidelines.

or

Copy of one of the following proof of assistance:

Aid to Families with Children Social Security Disability Insurance, Food Stamps, temporary Assistance to Needy Families,Supplemental Security Income, Women, Infant and Children’s Program (WICK), Medicaid, Children’s Health Insurance Plan, Section 8 Public Housing, Home Energy Assistance Program, Free/Reduced School Lunch
Please upload proof of Outreach*

Browse Files

Cancelof
Signature

Clear
SIGNATURE OF ATHLETE, PARENT OR GUARDIAN
Date

MonthDayYear
Date
Check if you would like to learn more about the USA Swimming Foundation's initiatives

YES
Check if you would like to receive the electronic USA Swimming Newsletter (must be 13 years of age or older)

YES
Are you paying by Credit?

YesNo
If paying by check, please mail a copy of this registration form and check to:

Metropolitan Swimming, Inc.

4949 Expressway Drive North, Suite 205B

Ronkonkoma, NY 11779

Membership Selection

Premium Membership$80.73

Includes CC Fee

Flex Membership$20.70

18&U only!

Outreach Membership$5.18

Single Meet Membership$22.77

Flex Upgrade $60.03

Life Time$1,049.49

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty: