Online Membership Form


Club Northwest - Membership Form

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Fill out the form below and send it with payment to:
Club Northwest
P.O. Box 31958
Seattle, WA 98103
You can email Becca Gillespy, becca@polevaultpower.com with questions.
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Name: _______________________________________

Birth Date:______________________________

Address: _____________________________________________

City:_____________________ State:_____ Zip:__________

Phone: Day: __________________

Evening:_____________________

email: ______________________

New membership Renewal

Student Membership ($40) ________
Regular Membership ($50) ________
Family Membership ($75) _________
Lifetime Membership ($750) _______
Freewill donation _________
TOTAL __________

Would you like to run with a group? If so, what pace, locations, and times are good for you?




Do you have a group of favorite events or distances that you compete or participate in? What are they?




What do you expect or would you like to see from Club Northwest? Reasons for joining?




May we post your phone, email and/or answers to #1 and #2 on the CNW website? (yes / no)
 

Would you like to be on the CNW listserver (you can unsubscribe at any time)? (yes / no)

Would you like us to send you team information? (yes/no)