Supplemental Member Information

Please fill out this form and return to Tim Bills as early as possible for entry into the unit database. Many events that we register for require this information for emergency purposes. Having the information on file will facilitate the registration process. It will also be kept on hand in case any of us suffer a medical emergency while at an event. Parents, please fill this out for each participating child as well.

 

Memberís Name:
Birth Date:
Emergency Contact:
Relationship:
(to Contact)
Day Phone:
(for Emergency Contact)
Evening Phone:
(for Emergency Contact)
Medications/Conditions:
If you'd prefer to be notified when the electronic version of the Legacy newsletter is available on the website and thus save the unit the cost of mailing one to you, please enter your email address below.
Electronic Legacy:

 


Problems notify: tim.bills@riag.com.