EmailMeForm
VIRA Membership Agreement – 2017
Checkbox
*
New Application
Renewal Application
Club or Organization Name for website:
*
Club or Organization Name
Contact Name
Mailing Address
City & Province
Postal Code
Website Address
Email Address
Contact Phone Number
VIRA Representative (if different from above):
Contact Name
Mailing Address
City & Province
Postal Code
Contact Phone Number
Alternate Phone Number
Email Address
President (if different from above):
Contact Name
Contact Phone Number
Alternate Phone Number
Email Address
How many races does your club plan to host in the coming year?
*
2016 Race Summary
Race Name
Race Date
# of Runners
Annual Membership Payment Options (select one)
*
$200.00 – VIRA members who will be hosting a race in the Vancouver Island Race Series 2017 – membership fee deducted from race proceeds.
$100.00 – VIRA members who will not be hosting a race in the Vancouver Island Race Series 2017.
VIRA member signing authority:
*
Name:
Title:
Date:
Please make cheques payable to Vancouver Island Runner’s Association,
(note we CANNOT accept cheques made payable to VIRA)
Please send payment to:
Judi Sigurdson,
1580 Prairie Street,
Victoria, BC
V8N 2L3
250-472-6886
judi.sigurdson@gmail.com
Powered by
EMF
Online Payment Form
Report Abuse
