Membership Registration Form

Ultimate Para Sports Association

2021 Membership Form
Participant name*

First NameLast Name
E-mail*
Phone Number:*

Area CodePhone Number
Address:*

Address (include apartment or unit number if applicable).

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date:*

MonthDayYear
Membership type:*
Program(s) of interest:*

Junior Adaptive Cycling ProgramRecreational Para CyclingDevelopment Racing Para Cycling ProgramCycling ToursJr. Para Cross Country SkiingPara Cross Country SkiingPara Cycling Indoor SpinEquipment RentalVirtual Home Strength Training
How did you hear about us?*
Upon completion of this form, please provide payment to Ultimate Para Sports Association via e-transfer to info.parasports@gmail.com.

Each member using equipment and/or participating in a sports program will be required to volunteer for our fundraising casino (occurs every 18 months). If you cannot volunteer, you are required to find someone to take your spot.
Signature
By clicking here, I electronically sign and agree to the membership conditions above.
Should be Empty:

Ultimate Para Sports Association