Membership Application Form

Calgary Warriors Track Club

Membership application for the 2016-2017 Season
Club Information & Fees *
Informed Consent *
Anti-Doping Program *
Code of Conduct *
Athlete Name *

First Name Last Name

Athlete Street Address *

Street Address
Street Address Line 2
City or Town	Province
Postal Code	Country

Athlete Gender *

Female Male
Athlete Email Address
Athlete Home Number *

- Area Code Phone Number
Athlete Cell Number

- Area Code Phone Number
Athlete Date of Birth *

- Month - Day Year
Athlete School Name *
Current Grade *
Preferred Events
Athlete Citizenship *
Required by Athletics Alberta
Athlete Country of Birth *
Required by Athletics Alberta
Alberta Health Care Number
Mother or Guardian Name *

First Name Last Name

Mother or Guardian Street Address *

Street Address
Street Address Line 2
City or Town	Province
Postal Code	Country

Mother or Guardian Email Address *
Mother or Guardian Home Number *

- Area Code Phone Number
Mother or Guardian Cell Number

- Area Code Phone Number
Mother or Guardian Work Number

- Area Code Phone Number
Father or Guardian Name

First Name Last Name

Father or Guardian Street Address

Street Address
Street Address Line 2
City or Town	Province
Postal Code	Country

Father or Guardian Email Address
Father or Guardian Home Number

- Area Code Phone Number
Father or Guardian Cell Number

- Area Code Phone Number
Father or Guardian Work Number

- Area Code Phone Number
Signature *
Enter full legal name
Signature date *
Should be Empty:

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