Registration

Prefix: First Name: Middle Name: Last Name: Suffix: Birth Date(MM/DD/YYYY): / /

NENSA Club USSA Number FIS Number

Address: City: State: Province (Foreign) Zip Code: - Country:

Preferred Contact Method

Phone

Email: Email 2: Phone: Evening Phone:

Coach Certification Level Coach Certification Year Coach Level Technical Delegate

Yes

Technical Delegate Certification Year

Education Level High School Name High School Grad Year College/University Name Degree Achieved College/University Grad Year

Year started xc skiing How I started xc skiing What I love about xc skiing Favorite ski program I have been a part of

Neon CRM by Neon One

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