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TRIFACTRI
Home
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Blog 2
Trifactri Membership and Athlete Information form
Membership
*
Indicates required field
Membership Option (pick one)
*
R600.00 per annum - includes free swim cap
R1,200.00 per annum - includes a Sportful Trifactri cycle top & free swim cap
Banking details: TRIFACTRI PTY LTD
Standard Bank
Account number - 332726649
Branch code - 001206
Thank you Lucie & the Trifactri team
Please use your initial, surname & 2019 as your payment reference eg. LZelenkova2019 and email p.o.p to:
[email protected]
Athlete Information
Name
*
First
Last
Email
*
D.O.B
*
I.D.Number
*
Telephone (H/W)
*
Mobile / Cell Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Male/Female?
*
Male
Female
Marital Status
*
Single
Married
Other
Dependants 1
*
Dependants 2
*
Dependants 3
*
Dependants 4
*
TSA Membership no.
*
Provincial Membership No. (R.S.A.)
*
Running T / Vest
*
XS
S
M
L
XL
XXL
Cycle Top
*
XS
S
M
L
XL
XXL
Cycle Shorts / Bib Shorts
*
XS
S
M
L
XL
XXL
Tri-suit
*
XS
S
M
L
XL
XXL
Athlete Emergency Contact Information
Name 1
*
First
Last
Relationship to Athlete
*
Mobile / Cell No.
*
Alt No.
*
Name 2
*
First
Last
Relationship to Athlete
*
Mobile / Cell No.
*
Alt. No.
*
Athlete Medical Information
Medical Aid
*
Medical Aid Number
*
Medical Aid Plan
*
Family Doctor
*
Contact Number
*
Blood Group
*
Allergies
*
Medical Conditions
*
Submit
Home
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Blog 2