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PLEASE NOTE If you prefer to pay via check, you can download the new 2013 BTC Membership Form Here and send it in to the address listed on the form.

Boulder Track Club Membership Form 2013

First Name: *

Last Name: *

D.O.B: *

Gender: *

Male Female

Phone #: *

Email: *

Current Address: *

City: *

State: *

Zip Code: *

Country: *

Please mark which categories interest you:

Basic Membership Youth Club (Ages 5 -12) Training Group Options Local Race Team Development-Elite Team Masters (Ages 40+) Mountain - Ultra - Trail Training Group (MUT's) MUT's Race Team

T-shirt OR Singlet:

T-shirt Singlet

Size:

Youth Club applicants can only order a T-Shirt

Size:

Athletic Background - Personal Records
	Life Time	Since 1/1/2012
5km
10km
Half Marathon
Marathon

Membership Fee 2013

$50.00Annual Adult Membership Fee (18 - 60 years):
$35.00Annual Senior Membership Fee (60 years or older):
$35.00Annual Junior Membership Fee (12 - 18 years):
$25.00Annual Youth Membership Fee (5 - 12 years):

Membership Includes

BTC T-Shirt or Singlet, discounted product/ entitlements courtesy of sponsors, coaching options, club newsletters/ media releases and invites to all club functions/ group runs.

I authorize the verification of the current information provided on this form and by signing below, I acknowledge that I am familiar with the club's by-laws as published on the BTC website and I agree to actively promote the club's mission statement.

Full Name: *

Date: *

Enter the characters below:

After submitting this form you will be redirected to Paypal for membership payment.