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Member Sign Up

Interested in becoming a member? Simply fill out this and the following page, send them in with your check and your in! You can pick up your "T-shirt" at Shosie's Cyclery and within a couple of weeks (give or take) you'll receive your gift certificates and membership cards in the mail.

Rockford Tri Club
Membership Form

Date: _____________

Last Name: ____________________________  First Name: ___________________

Address: _________________________________  City: _________________________

State: ____  Zip: __________________  Home Phone: __________________

Work Phone: _______________   Alt Phone: _______

Prefered Email: ___________________________   

Gender: _____   Birthdate: __________   Years in Triathlon: _____ 

Number of races completed: _____

Goals for the season (circle those that apply):   

Ironman    ½ Ironman    Olympic    Sprint    First Tri

Rank your strengths (1, 2, 3 - 1 being strongest): 
Swim _______ Bike _______ Run ________

A long bike ride for you would be:  ______ hours and / or ______ miles

A long swim for you would be:  ______ minutes and / or  ______ laps

A long run for you would be:  ______ hour(s) and / or   _______ miles

What would you like to get out of the club? _______________________________________________________________________

What can you offer the club? ________________________________________________

Membership:   _____ 2005 New Membership ($30.00)

Please make checks payable to Rockford Tri Club.

Mail to:
Rockford Tri Club
c/o Shosie's Cyclery
514 Windsor Road
Loves Park, IL 61111