MEMBERSHIP APPLICATION
 
Print this form and mail to:
SJAC
PO Box 563
Haddonfield, NJ 08033
 
___ New Member          ___Renewal           ___Change
 

 

Membership Type:

 
___ Individual ($20.00) ___Family ($25.00)
 
 
_____________________________________________________________
Last Name First Name MI
 
_____________________________________________________________
Street Address
 
_____________________________________________________________
City State Zip
 

Preferred Name: ______________________________________________

 

Gender: ___ Male ___ Female
 
Birth Date: ____ / ___ / ______
   month -- day -- year
______________________________________________________________
email address (most club info is distributed by email)
 
Phone No.(s) you want us to use:
Home: __________________________________
Work: __________________________________
Cell: ____________________________________
 

How did you hear about us? ________________________________________________

If registering as a family, please list your other family member and dates of birth here:                

 

 

Are you a member of USATF (USA Track & Field)?  Yes __________     No __________

 

Are you a member of USAT (USA Triathlon)             Yes__________       No __________   

 

 
SJAC Home