Emerald Coast Triathlon Club Membership Application Name: Individual or Family Membership Address: City: State: Zip Code:

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Cell Phone Number: Home Phone Number: E-mail address Would you like Emerald Coast Tri Club to share your phone number with other members of the club? Would you like Emerald Coast Tri Club to share your e-mail with other members of the club? Membership Dues: $25 for an individual $40 per family (living in the same home)

Make checks payable to: Emerald Coast Triathlon Club Mail to: EC Tri Club PO Box 1804 Niceville, FL 32588