Please fill out this information completely (This information will be kept confidential.)
Name: _____________________________________________________________________
Date of Birth: ____________________________________
Sex: M / F
Physical Address: _____________________________________________________________
Mailing Address: ______________________________________________________________
E-mail address: ________________________________Phone : (h) ______________ (w) ______________ (c) ______________
Emergency Contact Person: _____________________________________________________
EmergencyPhone Number: (if different from above) ________________________________________________________________
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NEW APPLICATION: $40
RENEWAL: Free this year for current members
JUNIOR: $15 (Under 18 yrs old on 9/1/16)
Payment can be made by mailing a check to:
Virgin Islands Triathlon
PO Box 24331
Christiansted, VI 00824
Or by PayPal to: shopping@vitf.org
The membership period extends from September 1, 2016 to August 31, 2017.
VITF benefits remain available with annual renewal.
License fee received by : _______________________________
Paid in full? yes / no
How was it paid? cash / check / PayPal
Date: __________________