MESI CLUB Information
Maine Swim Office is collecting Club information - Club Contact, Club Registrar, HOD Club Representative, Alternate HOD Club Rep, Club Athlete Rep and Safe Sport Coordinator
CLUB NAME
*
NAME OF PERSON COMPLETING THE FORM
*
First Name
Last Name
Email of person completing the form:
*
example@example.com
Name of Club Contact (can be head coach or another member of your club)
First Name
Last Name
Club contact email address
example@example.com
Cell phone of club contact
Please enter a valid phone number.
HOUSE OF DELEGATE REPRESENTATIVE (Must be USA-S registered member in good standing)
First Name
Last Name
HOD REP Email
example@example.com
HOD REP Phone Number
Please enter a valid phone number.
HOUSE OF DELEGATE ALTERNATE (Must be USA-S registered in good standing )
First Name
Last Name
ALTERNATE Email
example@example.com
ALTERNATE Phone Number
Please enter a valid phone number.
SAFE SPORT REPRESENTATIVE (MUST BE USA REGISTERED AND IN GOOD STANDING)
*
First Name
Last Name
SAFE SPORT Email
*
example@example.com
SAFE SPORT Phone Number
*
Please enter a valid phone number.
TEAM ATHLETE REPRESENTATIVE (SHOULD BE AGE 15 and OVER)
First Name
Last Name
ATHLETE Email
example@example.com
ATHLETE Phone Number
Please enter a valid phone number.
Submit
Should be Empty: