The Micheli Center Registration

Member Information
Name*
First Last
Date of Birth*
Please note participants must be at least 16 years of age.
MM slash DD slash YYYY
Email*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Membership Category*
- Introductory
- Family
- Single
- U.S./World Championships Competitor
- Team
Do you have any allergies?
Emergency Contact Information
Emergency Contact Name*
First Last
Email*
Phone*
Relationship to Participant*
(Father, Mother, Son, Daughter, Friend etc.)
Terms and Conditions
I agree to follow all rules set by The Micheli Center regarding participation and safety. I understand the rules regarding the cancellation of my membership with The Micheli Center and the responsibility of all financial obligations, and I agree to be bound by their terms and conditions.*
Yes
Electronic Signature*
First Last

Member Information