TRI NorthWest Membership Form 2009 Website: www.racecenter.com Email: trinw@racecenter.com Phone: (503) 644-6822 Fax: (503) 520-0242
Instructions
Membership Type (choose one) One-Year Membership - $35.00 - Memberships expire in January Two-Year Membership - $65.00 - Memberships expire in January
First Name / MI / Last Name
Street Address:
City:
State/Province:
Zip/Postal Code:
Birthdate (mm/dd/yy (not 2009)):
Age:
Gender: Male Female
Phone:
Email Address (non-business - to receive updates and press releases relating to Tri NW)
Provide Names of Running/Cycling/Tri Clubs that you are a member of:
Check#:
Amount Enclosed:
Official Use Only
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