REGISTRATION YEAR 2018

PENANG AMATEUR SWIMMING ASSOCIATION

Swimming / Water Polo / Synchronized Swimming / Diving

Registered Affiliate Club:

Name:

Date of Birth: Birth Cert./NRIC No: Sex: M /F

Home Address:

Contact Tel. No./Nos: Email:

I, ____________________________________________, whose name and personal particulars are as

stated above, hereby confirm my registration with the Penang Amateur Swimming Association (P.A.S.A.)

through the _____________________________________________ (name of club/affiliate) and shall

abide by the rules & regulations of the Association and my registered Club and shall abide by the

conditions that :-

1. I am subject to all decisions made by P.A.S.A. or my registered Club at all times and consequently

subject to any disciplinary actions imposed, and as governed by P.A.S.A., ASUM & FINA.

2. I am required to represent my registered Club, the Penang Amateur Swimming Association (P.A.S.A.)

and the state of Penang at all Championships or Competitions in the year 2018 if nominated and selected

by my registered Club or P.A.S.A. or the state of Penang.

3. In view of (2) above, I shall not permit my name to be entered by or to represent another State,

Association or Club in any Swimming Championships or competitions for the year 2018 irrespective of

whether I do or do not qualify for inclusion in the Club, P.A.S.A. or Penang State Team for the

Championships or competitions without the written consent of P.A.S.A.

Signature of Swimmer / Diver / Synchronized Swimmer / Water Polo Player:

Date:

For Those Under 18 years old

I, being the parent / legal guardian of __________________________________hereby give my consent

for him / her to be registered with the Penang Amateur Swimming Association (P.A.S.A.). I fully

understand, agree and will be subject to these rules, terms and conditions.

Signature of Parent:

Name of Parent: Date:

Contact Tel. Nos.: Email:

Signature of

Club/Affiliate Official: Club/Affiliate Stamp:

Name:

*Please attach copy of applicant’s passport photo / NRIC / Birth Certificate

*The above shall encompass all involved in the aquatic disciplines of swimming, diving, synchronized

swimming & water polo.

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Received Annual Registration fee of RM 20.00: Paid: