Please fill in the following form completely, then click the Submit button at the bottom of the form. Items marked with * are required.
Prices valid for memberships from 1/1/2009-12/31/2009.
I. MEMBER INFORMATION
* Date Your Membership Should Begin: -- pick month -- Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. -- pick day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2009 2010
* First name:
* Last name:
* E-mail address:
* Address: * City: * State/Province: * Zip/Postal Code:
* Primary Phone: () - Work/secondary Phone: () -
Birth date: -- pick month -- Jan. Feb. Mar. Apr. May June. July Aug. Sep. Oct. Nov. Dec. Year (YY):
Sex: Male Female
Emergency contact: Relationship: Emergency contact phone: ()- Emergency contact alternate phone: ()-
Physician: Physician phone: ()-
Medications currently taking:
Please list any serious illnesses, medical conditions, or physical limitations:
Have you had any sport-related injuries? If so, please describe:
How did you hear about Tattersols/Team Sheeper?
II. MEMBERSHIP TYPE AND REGISTRATION FEES
I am a full time student. Where?
I am 65 years of age or older
I qualify for the family member discount and live at the same address as primary member
* Pick ONE membership type:
Payment for online registrations must be made by credit card.
* Card Type: --pick one -- Master Card VISA Discover Sorry, AMEX, others, not accepted.
* Name on the Card:
* Card Number:
* Expiration Date: -- pick one -- 1 2 3 4 5 6 7 8 9 10 11 12 -- pick one -- 2009 2010 2011 2012 2013 2014 2015
III. WAIVER AND ACKNOWLEDGEMENT OF TEAM POLICIES
1. The sports of triathlon, swimming, cycling and running involve the extreme test of a person’s physical and mental limits and carries with it the potential for death, serious injury, and property loss. Member’s initialing of this paragraph acknowledges that member certifies that he/she is physically fit and has not been advised against participation in these sports by a qualified health professional. Check here to acknowledge*:
2. I understand the risks involved with training for and competing in the sports of triathlon, swimming, cycling and running, and agree to indemnify and hold Team Sheeper L.L.C., its employees and officers, the City of Redwood City, its employees and officers, and the Menlo Masters, its employees and officers, harmless from and against any and all liability for injury or property damage that may arise from any training or competition connected to the activities of the Team or Teams. Check here to acknowledge*:
3. I acknowledge and agree to the team policies listed below. Check here to acknowledge*:
Date*: -- pick month -- Jan. Feb. Mar. Apr. May June July Aug. Sep. Oct. Nov. Dec. -- pick day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2009 2010
POLICIES:
Notes/Special Instructions:
Click Submit button to submit to our secure Web site.