Name(s)

Address

Email(s)

Phone(s)

Birth Date(s)

Events

Sprints
 
Hurdles
 
Middle
Distance
Distance
 

Race Walk
Throws
 
Jumps
 
Multi-
Events

Sprints
 
Hurdles
 
Middle
Distance
Distance
 

Race Walk
Throws
 
Jumps
 
Multi-
Events

New Member
T-shirt

  S
  M
  L
 XL
XXL

  S
  M
  L
 XL
XXL

Other
Participation
Interests

Serving on
Committee
Officiating
 
Helping
at Meets
Board
Member

Serving on
Committee
Officiating
 
Helping
at Meets
Board
Member

Mail to (w/check payable to Portland Masters Track Club):

Richard Ying  (ph: 360-834-3452)
PMTC Membership Chair
1635 NW Deerfern St.
Camas, WA 98607