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North York Aquatic Club 12 Bannockburn Ave., Toronto, ON M5N 2M8 PH: 416-785-0430 FX: 416-785-9697 e-mail: nyacswim@yahoo.ca

Triathlete Swim Training Program Registration Period: November 15, 2010 – September 16, 2011

Name:

Date of birth m/d/y:

Home Phone #

Emergency Tel.#

E-mail:

OAT #

Address: Street Address & Suite/Unit #

Practice schedule:

Monday & Wednesday Friday Monday & Friday

City

Province

Glendon College or Havergal College Douglas Snow Aquatic Centre Havergal College

Postal Code

6:00-7:00 am 5:30-7:00 am 5:45-7:15 am 7:30-9:00 pm (this program starts January 3, 2011)

Please note that pool location may change due to pools availability, there is no swimming on holidays, monthly schedule will be e-mailed to swimmers and posted on NYAC website

November 15, 2010-June 13, 2011 Monday, Wednesday & Friday mornings Please check which day you will attend: # of practices Monday

Wednesday

Friday

Membership Fees

Once a week

355.00

Twice a week Three times a week

560.00 780.00

November 15, 2010-June 13, 2011 Combination Evening and Morning. Evenings starting January 3, 2011 Please check which day you will attend: # of practices Monday Wednesday

Friday

Membership Fees:

Monday

plus

Morning

Friday

Evening

One Morning + One Evening a week One Morning + Two Evenings a week Two Mornings + One Evening a week

520.00 700.00 740.00

January 3-June 13, 2011 Monday & Friday Havergal College 7:30-9:00 pm Please check which day you will attend: # of practices Monday

Friday

Membership Fees

282.00 480.00

Once a week Twice a week

Payment schedule: (please check one) June 13- September 16, 2011

□ single payment due November 1 □ two equal payments dated November 1 and April 1

Any day, any # of practices

□ 285.00 single payment due June 1, 2011

Credit Card authorization: Card #

Expiry Date

Name as printed on the card

Signature

Month

Year

I hereby make application for membership in the North York Aquatic Club and agree upon this application to become a debtor to the Club for the full amount of the membership fees. All swimmers must be registered with Ontario Association of Triathletes for insurance purposes. NYAC membership fees include OAT membership fees only for athletes who submitted OAT application form to NYAC before February 1, 2011.

_____________________________________ Signature

_____________________

____________

Date

Total Fees paid


http://csca.org/NYAC/2010-2011-NYAC-Tri-Swim-Registration-Form-01