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Harry Jerome 2021 Confirmation
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Gender
*
Female
Male
Other:
Birthdate
*
Using birth year (e.g. April 16, 1998)
MM
/
DD
/
YYYY
BC Athletics / Athletics Canada Number
*
E.g. 97-12345
Your answer
Club/Affiliation
*
To be listed beside your name on results (e.g. Langley Mustangs)
Your answer
Training base
*
Lower Mainland
Vancouver Island
Interior BC
Outside of BC
Other:
Coach's email
*
Your answer
Are you on a high performance list
*
BC CSI-P
AC Long List
AC Nationally Carded
None
Not Sure
Other:
Required
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