TRI-STATE ADAPTIVE SPORTS ASSOCIATION
Member Application form
Registration type:
*
New Member
renewing member
renewing member with updates
Your Name
*
First Name
Last Name
Your Email
*
Phone Type:
*
Please Select
Mobile
Landline
Phone type
Phone Number
*
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Area Code
Phone Number
Date of Birth
*
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Month
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Day
Year
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Your Address
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Street Address
Street Address Line 2
City
State
Zip Code
How would you like to be contacted?
*
Phone Call
Text
Email
Letter
Newsletter
Yes, subscribe me to this newsletter.
Accommodations for your participation:
Ie. Interpreter, alternate communication formate
Medical information you would like to disclose?
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Emergency Contact info:
Name of Emergency Contact
*
First Name
Last Name
Phone Number of Emergency Contact
*
-
Area Code
Phone Number
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Participation Agreement Form
Do you agree to the following terms?
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Social Media Photo Release Form
Age:
Gender:
Female
Male
Other
Can we use your Name?
Complete Name
First Name
Anonymous
Please read and check the box:
*
I grant TASA to use my photos on Facebook, Twitter, Instagram, and other social media platforms.
I allow TASA to edit, alter, copy, or distribute the photos for social media advertising and marketing.
I agree that the photos belong to TASA.
I understand that I will not receive any monetary compensation.
Signature: By typing your name you are agreeing to the terms above:
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Date Signed:
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Month
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Day
Year
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