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Prénom *

Nom *

Sexe *

Homme Femme Non binaire

Date de naissance (AAAA *-MM-JJ)

/ /

Adresse postale - Adresse *

Adresse 2

Ville *

Province / État *

Pays *

Code postal *

Is the above athlete a NEW or RETURNING athlete? *

School

Please list your athlete's preferred events *

Mother/Guardian's Name *

Mother/Guardian's Phone Number * - Téléphone international

Father/Guardian's Name *

Father/Guardian's Phone Number * - Téléphone international

Adresse e-mail * Recevoir des courriels

Additional Email (if applicable) Recevoir des courriels

Type d’adhésion *

2025/26 Bermuda Pacers