Please fill in applicable information. If this is a renewal, we probably have your info on file.

NEW_____________ RENEWAL_____________
 

Name: ___________________________________________________________

Additional Family Members: ___________________________________

Address: _________________________________________________________

City/Prov: ___________________________________ Postal Code: ________

Phone (H): ______________ Phone (W): ________________

E-Mail Address: ___________________________________________

Birthdate #1: ______________________________________________________

Birthdate #2: ______________________________________________________

Birthdate #3: ______________________________________________________

(Note, please list birthdays in order of members on list)

Signature: ________________________________________Date: _____________
 

Fee enclosed: Fee: $25.00 - single. $50.00 - family

(Cheques payable to Wapiti Striders Track Club)

How many years have you been competing?  ____________________

What events are you primarily interested in?  _____________________________________

What are your PBs and year acheived (if known) in your primary events?   ____________________________

Are you (or your parent) interested in helping out as a coach or manager?  ______________________________

Please complete form and forward (with appropriate fee) to:

Wapiti Striders Track Club

10278 110 Avenue

Grande Prairie, AB

T8V 1S7