2017-2018 Membership Form

Member # ___________________


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: __________________