2017-2018 Officials Membership Form Question Title * 1. Personal Information First Name * Last Name * Address * City/Town * Province * Postal Code * Date of Birth (YY-MM-DD) Email Address * Phone Number * Question Title * 2. Member Club Affiliation No Affiliation BC Aquasonics Burnaby Caprice Comox Valley Orcas Fraser Valley Masters Haney Neptune Aquatic Club Hollyburn Synchro Kamloops Sunrays Kelowna Dolphins Nanaimo Diamonds Nelson Prince George Water Lilies Pacific Wave Synchro Ravenson Waterdancers Revelstoke Rainbows Vancouver Masters Synchro Vernon Silhouettes Victoria Synchro Westcoast Masters Other (please specify) Question Title * 3. Membership Category Level I (Provincial) Level II (Provincial) Level III (National) Level IV (National) Level V (International Trainee) FINA G FINA B FINA A Don't know UANA Level 5 Question Title * 4. Membership Fee Synchro BC ONLY ($25.00) Synchro BC Waived ($0.00) * must have judged/refereed at least 2 meets during the 2016-17 season Synchro Canada ONLY ($20.00) Synchro BC & Synchro Canada ($45.00) Please submit your payment for the balance due by the registration deadline to ensure your registration is complete. Question Title * 5. By clicking CONFIRM, I hereby acknowledge that I have fully read the Code of Conduct and recognize that it is intended to uphold the integrity of this organization and its members. CONFIRM SUBMIT