Israeli Triathlon Association

Membership Registration Form 2010

Valid through 31 Dec 2010

New Members will receive their own timing chip with Velcro strap, race number and swim cap.

Membership : 320 NIS Renewal: 250 NIS

Children: 140NIS Renewal: 120 NIS

New Member/Renewal

Name:______________________

Birth Date:________________ Signature:________________ Nationality:_______________________

Address:______________________________Zip_______

Tel:_________ Mobile :__________________

Fax:_____________________

E Mail:______________________________

Team:___________________________ ID:____________________

Profession :________________________________________

I can help the Association with:_________________________

For registration mail a check to the Association or fill Credit details and Fax to 03-6764260!!

Card:______________

Card Holders name:______________________

Tel:______________________ID:____________________

Card number:___________________________________

Valid Through:____________________Sum:__________

Please attach passport picture for issue of member card.