Member Registration

Austin T3 - Team Triathlon Training

2013 Membership Application

Personal Information:

*Last Name*
*First Name*
*Address 1*
*Address 2*
*City*
*State*
*Zip*
*Phone*
*E-mail*

*Gender*	Female Male
*Birth Date*	mm/dd/yyyy

Triathlon Background:

How many years in triathlon?
How many races have you completed ?
What is your upcoming race?
How did you hear about T3
Were you referred by someone?

Austin T3 Coaching Staff needs to know:

What are your expectations from the program and the coaching staff?

What would you like to achieve under the T3 Training Programs?

Click on the type of membership you would like to sign up for:

** All plans are billed monthly and all plans can be stopped at any time due to there not being a commitment contract. There is a annual membership fee. (Month-to-Month or Season Plan).

Season Plans are available for athletes looking to save $$ over the period of the full year. Season plan holders must be registered by April of each Year to take advantage of the savings.

Each member will receive team apparel the upon registration. Team T-Shirt
Each member will also receive a consultation to make sure that the athlete gets started properly.

Be sure to read the Payment Authorization Guidelines below for stopping memberships. For any questions contact the coaching staff at 512-899-2482

I would like to start my membership on this date: mm/dd/yy

Payment Information:

You have the option for membership payment of Credit Card billing or Bank Draft.

Please fill out one form of payment only.

Bank Draft:

Name on the Account:
Bank Name:
(Date to be drafted)	1st (You will be pro-rated to the 1st of the month)
Routing Number:
Account Number:

Credit Card Draft:

Name on the Credit Card:
Type of Card
(Date to be drafted)	1st (You will be pro-rated to the 1st of the month)
Account Number:
Expiration Date:	Month Year
CW2	(3 digit code on the back)

Austin T3- Team Triathlon Training Payment Authorization

Membership with the Austin T3 – Team Triathlon Training club is nontransferable and nonrefundable. It is to my complete understanding that if I wish to terminate or change my membership in any way, I must give the Austin T3 - COACHING STAFF a fifteen (15) day written notice or email prior to my next billing date. I understand that if I participate in a practice once I have terminated my membership, I will get an additional bill for the complete month of training.

The Austin T3 – Team Triathlon Training Programs and Clinics do not anticipate changes in fees or rates, but may adjust the monthly rates applicable to different program categories. The member will receive a (thirty) 30 day notice prior to any such change. Should any member debt not be honored by the member's bank or credit card Company for any reason, the member is still responsible for that payment plus a service charge applied by Austin T3 – Team Triathlon Training Programs and Clinics. This is in addition to any service fee the member's bank or Credit Card Company may charge. The membership is subject to termination if the debt is not paid.

This agreement serves as authorization for continuous billing of monthly membership fees and/or program fees, merchandise sales, and service fees including, but not limited to, returned draft and overdraft fees.

The Austin T3 membership is on a month to month basis. Austin T3 may put training dues on a ‘Freeze’ for the duration of no longer than thirty (30) days in case of a family emergency, injury or loss of employment. Please contact staff if there is an issue they may need to consider for freeze in membership.

Please initial to agree with the terms and conditions for the Austin T3 - Payment Authorization.

Medical Release Form

I hereby authorize Austin T3, Inc Clinics & Programs to provide me with medical care and treatment and emergency medical services associated with participation in this program. In addition, I agree to pay all costs associated with my medical treatment or transportation. I further authorize the release of any medical information necessary to process a claim for accident / medical payment insurance for an injury or illness incurred while participating as member of the Austin T3, Inc Program.

I understand and appreciate that my participation in the sports of swimming, cycling and running carry a risk of serious injury, including permanent paralysis or death. I voluntarily and knowingly recognize, accept, and assume this risk.

I, agree to save and hold harmless the Austin T3, Inc Clinics & Programs or their respective coaches, officers, directors, agents, representatives, or employees for any and all damages that may be sustained or suffered by me in connection with, or arising out of my traveling to, participating in, and returning from the Austin T3, Inc Program. I also agree to indemnify and hold harmless Austin T3, Inc Clinics & Programs, and all related entities for any damages incurred arising from any claims, demand, action, or clause of action by the participant.

In the event I am injured or should require medical attention, I hereby authorize Austin T3, Inc Clinics & Programs to contact the physician listed. In the event the doctor cannot be reached, I hereby authorize the coach or other Austin T3, Inc Clinics & Programs representative to secure necessary medical treatment. If possible, confirmation of this authorization should be made with me prior to treatment, by calling me at the numbers listed on this form. In case I cannot be reached, or in case of emergency, medical treatment as described may proceed without further authorization.

Electronic Signature Date