Please print or type. Complete the form fully. Sign it, certifying that you initiated contact with
your new club. Have the Club Representative from your new club sign it, certifying that they have
given the notification required by Appendix J of the Rules and that they did not recruit you. Mail,
e-mail, or fax a copy of the completed, signed form to our National Office:
U.S. Synchronized Swimming
132 East Washington St, Suite 820
Indianapolis, IN 46204
(317) 237-5705 (fax) (317) 237-5700 (Phone)
[email protected] (email)
The rule regarding transfers from one club to another is contained in Part Two, Article 21, of the
Rulebook (Section 21.01, D):
Transfers: To transfer representation from one (1) club to another, an athlete member must
serve one hundred and twenty (120) consecutive days without having represented any club
in competition, regardless of residency. An athlete member must complete a transfer form
indicating the date of last competition in an attached status. The form shall be submitted to
the National Office.
The rules regarding notification of your former club and association, and new association are
contained in Appendix J of the Rulebook.
Last Name: ____________________________ First Name:
Date of Birth ___________________________
Previous Club Name: _____________________________
Previous Association: _____________________________
Date of your last competition representing previous club: ______________________________
Name of your New Club: ____________________________
New Association:
Effective Date of Transfer (120 days from the date
of the last competition representing your previous club): _________________________________
ATHLETE'S CERTIFICATION: I certify that the information contained in this form is accurate,
and that I, or my parent or guardian, initiated contact with my new club.
Signature of Athlete
PARENT OR GUARDIAN'S CERTIFICATION (if the athlete is a minor): I certify that I am
the parent or guardian of the athlete identified in this Transfer Form, and that s/he, or I, initiated
contact with his or her new club.
Name of Parent or Guardian
Signature of Athlete's Parent or Guardian
CLUB REPRESENTATIVE'S CERTIFICATION: I certify that my club has notified the
athlete's previous club, its coach, the Association of which that club is a member, and the
Association of which my club is a member, of the athlete's intention to transfer to my club. I also
certify that the athlete, or his or her parent or guardian, initiated contact with my club, and that my
club has neither recruited nor initiated contact with the athlete or his or her parent or guardian.
New Club Representative's Name
Signature of New Club Representative