TRAS MEMBERSHIP APPLICATION 

Date of Application  ____________Date of Birth ____________

Name  ____________________________________________________________

Address  __________________________________________________________

City/State/Zip Code  ________________________________________________

Phone Numbers (home) _____________________ 

       (work)______________________

E-Mail Address  __________________________       Sex:  Male  Female

Disabled   Non-disabled    Veteran - which war? __________________

Specify Disability  __________________________________________ 

Date of Onset  ______________________________________

List Family Members (family membership only)

____________________________________________________________________________________________________________________________________________________________________________________________________________

Please list any allergies or restrictions/limitations we should be aware of during activities:

____________________________________________________________________________________________________________________________________________________________________________________________________________

Membership Dues

(fees help pay for cost of mailings, insurance and chapter dues):

Individual ($20)Family ($30)$_________Patron Gift

Status: New MemberRenewal

Please make checks payable to TRAS and mail along with application to:

Three Rivers Adaptive Sports/ Membership, P.O. Box 38235, Pittsburgh, PA  15238