Tri4Success Triathlon Club

tri4success

Club Reg Form

Tri4Success Triathlon Club

Cranbrook/East Kootenay Region, BC

2018 CLUB MEMBERSHIP APPLICATION

 

* PRINT or /return via email - please print clearly (information is for club use only).

 

Last Name__________________________FirstName______________________Initial___

Sex: Male __ Female__

Birthdate: __________________ Phone: ____________________ cell___ or home___

(d/m/yr)

Mailing Address: ___________________________________________________________

City:_____________________________ BC_ Postal Code:_________________________

Email:________________________________________________

Tri 4 Success Club membership - check applicable type

Standard > $15.00 per person/ $25.00 for Family/ Free for U16

___ ADULT $15.00 Paid Y____ N___

___ Free – Youth Under 16

___ Family $25.00 Paid Y____ N____ (completed forms must be signed/dated for each family member)

 

Optional Training Program > 10 week coached sessions plus 16 wk training program (Tri-A-Tri) (contact Barb for more details, coaching available for all levels and a great starting point for beginners)

 

HealthCare #__________________________________

 

TRIBC member: Yes #______________ No __ OR Non-training membership_____

 

**To train or participate in club insured activities, member must be covered by Tribc insurance, member responsible to register or have current Tribc membership! As a club member you can register with Tribc under club name to receive a discounted membership.

RELEASE AND INDEMNITY

I, the applicant, on behalf of myself, members of my family, my heirs, executors Administrators and assigns, hereby forever release and hold harmless Tri4Success Triathlon Club representatives/coaches/executives and agents for any injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in any Tri4Success Triathlon Club organized events/training and activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of Tri4Success Triathlon Club representatives, coaches, sponsors or agents.

I have read and understand the above Release and Indemnity, and in witness thereof, I hereunder set my signature this day:

_______ of _______________ 20___

 

__________________________________ _______________________________

Printed Name Signature (or parent/guardian for U16)

 

__________________________________ ______________________________

Witness Name Witness Signature

 

Desired level of training: Novice ___Intermediate ___ Advanced ___ Coaching y/n ____

Current level within the sport of triathlon: Novice ___ Intermediate ___ Advanced ___Coaching levels: ______

Club contact: Barb Fode [email protected]

 

 

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