Mawa Invidual Member Registration

MAWA Individual Member Registration

First Name *

Last Name *

Address *

City *

Postal Code *

Province *

Phone Number (Land Line) *

Cell Number *

Email *

Date of Birth (MM-DD-YYYYY) *

Gender *

Male Female

Club (Primary) *

Coach ($35.00) *

Wrestling Grappling Both

Official ($35.00) *

Wrestling Grappling Both

Athlete Wrestling *

Athlete Wrestling ($35.00) Athlete Elementary Wrestling ($20.00)

Athlete Grappling *

Athlete Grappling ($25.00) Athlete Grappling Elementary ($20.00)

Volunteer ($20.00) *

Volunteer

Respect in Sport Completion *

Yes No

Respect in Sport Certification # *

Fees *