Triathlon and Cycling Club at San Francisco State University

SF State: Sport Club Member Information Form

SF State: Sport Club Member Information FormAll Sport Club members/participants must complete this form to be considered official members of a particular Sport Club. Only registered club members will be permitted to participate in sanctioned Sport Club competitions, tournaments, and be permitted to travel with the club on approved university activities held off campus.

Sports Club Team Name:

SF State Student ID

Name First,Last,Middle Initial

Gender

Male
Female

Date of Birth

Class Level

Freshman
Sophomore
Junior
Senior
Graduate Student

Address Street Name/City/State/Zip Code

Email Address

Phone Number

Do you have a driver's license?

Yes
No

Health Insurance Information

All Sport Club members are required to have individual health insurance coverage in order to compete in games and tournaments, as well as travel with the club. Please fill in your health insurance information.

Health Insurance Company

Policy Number

Policy Holder Name

Relation to Policy Holder

Person to Notify in Case of Emergency Please Identify a person to notify in cases of emergency.

Name of Person to Contact First and Last Name

Address Street/City/State/Zip Code

Cell Phone and Home Number

Relationship