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This survey collection will be used for the following  purposes:
Planning courses within in the Region in line with direct need 
Informing members as a priority when courses are available 

This form should be completed for individuals requiring courses rather than a generic club sign up, the email address may be generic however we do remove members once they are signed up to support with the course planning. 

The Region will continue to send available course information within the weekly information sent to to clubs   

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* 1. Name

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* 2. Membership Number

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* 3. Email 
This email will be stored by the Region for contacting you regarding assistant coach/coach courses

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* 4. County

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* 5. Club

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* 6. Courses required  - Please tick all that apply
Please note the following minimum ages apply to the course start date:
Assistant Coach: 16
Coach: 18 (pre requisite Level 1 Coach / Assistant Coach) 
Open Water: 17 (pre requisite Level 2 Coach /Coach swimming or Level 2 Teacher with OW experience)

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* 7. Notes - any information we should be aware of for course planning e.g. currently undertaking assistant coach and the finish date if wish to attend coaching (please include here if PAC/Practical Assessment only of the selected course is required)

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