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Adult Member Registration Form
Adult 1 name: *	(First and Last)
Adult 1 age group *	19&20 21-30 31-40 41-50 51-60 61+
Our club keeps our club fees reasonable however our Team Manager needs your help to run our activities especially our signature Family: Bunnyrabbit, Jackrabbit & Youth Challenge Programs. Please indicate your volunteer interest. * One or more selections required. *
Jackrabbit Committee
Jackrabbit Leader
Jackrabbit Equipment Coordinator
Jackrabbit Parent Helper
November Potluck organizer
April Potluck organizer
Wax Technician
Assist Waxer
ABCup 12 asst. team Manager
ABCup 34 asst. team Manager
ABCup 56 asst. team manager
ABCup 78 asst. Manager
Clothing Committee
Fundraising Committee
Membership Committee
Other	(Please specify)
Street: *
City: *
Postal Code: *
Primary Phone# *	(Where we can leave a voice message)
Emergency Phone# *
Emergency Contact's name: *	(First and Last Name)
Who reffered you to CNTG?	(First and Last Name)
Email Address: *
Password *	(Create your own special password for this website)
	Select 'I accept' below, to confirm that you have read and accept the Waiver of Liability. I accept *