UCLA Triathlon Membership Sheet
* Required
Full Name
*
Last, First
Member Since
*
2005 or prior
2006
2007
2008
2009
Status
*
Undergraduate
Graduate
Faculty / Staff
Alumnus
Other
E-Mail Address
*
Cell #
*
xxx.xxx.xxxx
Current Address
*
Don't forget to include any building or unit number.
City, State, ZIP
*
Emergency Contact Name
*
Emergency Contact #
*
Permanent Address
*
Don't forget to include any building or unit number.
City, State, ZIP
*
Country of Origin
France, Mexico, Korea, USA, etc... have pride in your home country!!
Parent Name(s)
If you choose to disclose this information and your parents live at separate addresses, provide one at a time – see below. (Last, First & First)
Address
Don't forget to include any building/unit #'s.
City, State, ZIP
Parent #2's Name
Do not fill out if your parents reside at a single address.
Address
City, State, ZIP
How did you hear about the team?