MERIDIAN STREAMLINERS

Member Information

Please make sure to fill out completely. This will help to set up your team account
accurately.

LAST NAME: ______________________ Mother’s Name:

__________________________

Mailing/Billing Address: Father’s Name:

__________________________

______________________________ Home Phone: ___________________________

______________________________ Mother’s Cell Phone: _______________________

Secondary Mailing Address: Father’s Cell Phone:

_______________________

______________________________ Main Email Address:

____________________________

______________________________ Secondary Email address:

________________________

Person Responsible for payment: _____________________________

Swimmer (s) Information:

Name: __________________________ Name:
__________________________

D.O.B. __________________________ D.O.B.

__________________________

School: _________________________ School:

__________________________

Grade: __________ Grade: __________

Name: __________________________ Name:

__________________________
D.O.B. __________________________
D.O.B.___________________________

School: _________________________ School:

__________________________

Grade: __________ Grade: __________