Masters / Tri - Spring Session (Cheque Payment)

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Personal Information

*E-Mail:

Valid e-mail is required

*First Name:

*Last Name:

*Local Address:

Local Address Line 2:

*City:

*Province

*Postal Code:

Gender:

Date of Birth:

*Phone:

Cellular:

Administrative Information

*Membership Status

Returning Member
New Member

All group members must be registered with either Triathlon BC or Masters BC.

*Current Membership

Triathlon BC
Masters BC
None

Membership Number

Tri-BC or Masters BC

*Ability Level

*Training Time

AM Times (Tues / Thurs) 5:30-7am - Long Course
PM Times (Mon / Wed / Fri) 7-8pm - Short Course

Select your Training Group

Emergency / Medical Information

*Emergency Contact

Full name of emergency contact

*Phone:

*E-Mail:

Relevant Medical Information:

ie.Allergies, diabetes, etc

Medications

Any medications you are taking

Payment Information

*Cost

$200.00

*I would like to pay using

Cheque

Important Notes:   
 
1.  All Credit Card payments will be charged a 3% administrative fee for a total cost of $206.00. 
3.  Any outstanding fees after April 14, 2008 will result in loosing your spot to someone on the wait list.

Please check the box below to indicate you understand that any cancellation after submitting this form will result in an administrative fee of $50.00 being charged.

*Cancellation Policy Agreement:

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