First Name: Last Name:

Address:

City:  State:  Zip Code:

E-mail:                                                

Home Phone:  Cell Phone:

Occupation:

Date of Birth:   Sex: Select Male Female  

USAT #:

 

Emergency Contact Name:

Relationship: Phone #:

 

Additional Information:

Number of years in Triathlon:

Ability Level: Select Beginner Intermediate Competitive Age Grouper Elite Pro  

Race Interests: Sprint  Olympic  Half Ironman  Ironman

Planned races for 2012:

Jersey Size: Select W-X-Small W-Small W-Medium W-Large M-Small M-Medium M-Large M-XL

 

Which aspects of the Team interest you?

Regular group works: Swimming Cycling Running

Discounts/Sponsors Products

Social (Training partners, post workout gatherings, pre-race gatherings)

Other:

 

Are you willing to volunteer at team events/activities: Yes No

 

How did you hear about the Pauole Sport Team:

Friend

Internet

Other: