Membership Request - Atlanta Rainbow Trout

Request Trout Membership

Name:

Email:

Mobile Number:

Birth Date:

Membership Requested:

Swimming and Water Polo Membership:

Primarily interested in:

USMS Membership Number (Required):

USAWP Membership Number (Required):

Are you interested in Triathlon training?:

Water Polo Only:

USAWP Membership Number (Required):

Student Swimming and Water Polo Membership:

A student id and university email address is required for the student rate.

When do you graduate?

Primarily interested in:

USMS Membership Number (Required):

USAWP Membership Number (Required):

Emergency Contact Name (Required):

Emergency Contact Phone Number (Required):

How did you find out about the Trout?

Name of referring Trout Member:

T-Shirt Size:

Message (optional)