Nomination Form

SSA TASMANIAN SWIMMING TEAM NOMINATION FORM 13 - 19 YEARS

25th - 30th July 2026, Melbourne.
Athlete Name

First NameLast Name
Name of Parent / Gaurdian

First NameLast Name
Athlete's School
Athlete's Swimming Club
DATE OF BIRTH
Age as of 31st December 2026
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
EVENT NOMINATIONS (Please nominate 6 events (max) that you wish to be considered for):
Nomination Fee:

Account Name: Tasmanian Swimming Inc

Account Number: 10423629

BSB: 067-000

Reference: Swimmer Surname

Amount: $200.00
Parent/Guardian Signature (if athlete is under 18 yrs) OR Athlete signature (if 18 & over)
Date Signed

MonthDayYear
Date
Should be Empty:

SSA TASMANIAN SWIMMING TEAM NOMINATION FORM 13 - 19 YEARS