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New Family Membership – Additional Members
Registration - New Member Registration - Additional Members
"
*
" indicates required fields
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Date Registered
Main Member Info
Main Member Name
First
Last
Family Member Information
Member Name
*
First
Last
Gender
*
Male
Female
Date of Birth
*
Month
Day
Year
Does this member have their own email address?
*
A unique email address is necessary to create a user account on the website to have access to the "Members-Only" information. You can request to be added as a user at a later time, if needed.
Yes
No
Email
*
Phone
*
Alt. Phone
Emergency Contact Information
Please provide your "in case of emergency" or ICE should we ever need to use it.
ICE Name - Primary
*
ICE Number - Primary
*
ICE Relationship - Primary
*
ICE Name - Secondary
If Primary Contact cannot be reached
ICE Number - Secondary
ICE Relationship - Secondary
More Family Members?
*
Yes
No
Email
This field is for validation purposes and should be left unchanged.
STL Tri Club
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