July
TEAM PSYCH TRIATHLON CLUB MEMBERSHIP APPLICATION Name (First, MI, Last) _____________________________________________________DOB_______________Age ______________ Family members: _____________________________________________________ _______________ ______________ _____________________________________________________ _______________ ______________ Address ___________________________________________City______________________State_______Zip_____________________ Phone (home) _________________________
Cell________________________________
Work____________________________
Email Address________________________________________________ Who referred you to Team Psych?______________________ Include me in the membership directory _____email ____phone
USAT #_________________________ T Shirt size_______
Rate your strengths ( 1 = poor, 2 = fair, 3 = good ) Swim_______ Bike______ Run______ Training area you would like mentoring: _____________________________________________________________________________ Training area you would mentor teammates:__________________________________________________________________________ Volunteer Interests: _____event planning _____Membership _____Newsletter _____socials planning _____Photography _____Publicity _____ Race for the Booty Hop
_____ Charity Fund Raising _____Organizing Relay Teams _____ Corporate Sponsorship _____ Youth Triathletes _____ Race for the Booty Tri
Membership Description Active Duty Military
Amount $0
——-
New Single Member Diamond (One Race Day Tri Tank, Tri Short & T Shirt)
$160
$
New Single Member Gold
(One Race Day Tri Tank & T Shirt)
$100
$
New Single Member
( Decals, Tattoos, Discounts & One T-Shirt )
$50
$
New Family Membership
( Decals, Tattoos, Discounts & Two T-Shirts )
$85
$
Renewal Member Diamond
(One Race Day Tri Top & Tri Short , Socks, )
$125
$
Renewal Member Gold
(One Race Day Tri Top, Socks, )
$75
$
Total
Renewal Single Member
( Socks, Decals, Tattoos, Discounts )
$25
$
Renewal Family Membership
( Socks, Decals, Tattoos, Discounts )
$40
$
$15 ea
$
Additional T-Shirts
Sizes:
Payable to: Team Psych Check, Money Order, or Visa____ MC____
Total
$
#_________________—______________—________________—__________________ Expiration:_____/ ______ Waiver: This section must be signed before the application will be accepted. (If under 18 a parent or guardian must sign). I do hereby waive and disclaim, for myself, my heirs, and assigns, any and all claims for personal injury or property damage which may occur in connection with any Team Psych Triathlon Club activity. I will be completely responsible for myself, and guests and any minors under 18 whom I may bring or allow to participate in a club activity. I allow all photographic images for use by Team Psych. This statement also pertains to travel to and from club functions. Date:________________________ Signed:__________________________________________________ Date: _______________________ Parent / Legal Guardian_____________________________________ Mail to: 17001 Amber Lake Ct Lutz, FL 33549 fax 813-968-5051 - phone 813-210-6484 - MDavis@TeamPsychTri.com
Or register online at TeamPsychTri.com
ht
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Come visit our website for exciting new developments. http://www.davissoundmind.com/ SportsPerformancePsychologyAthleteAssistanceProgram.en.html
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http://events.braintumoralliance.org/site/TR?fr_id=1190&pg=entry
Let's get brainwashed St. Pete! August 8, 2015 - South Straub Park Join us for the Brain Tumor Alliance Great BrainWash - a wet and wild fun run for the whole family. You'll run a 5k throughout the amazing downtown St. Pete waterfront tackling fun inflatable water obstacles (and maybe a few other challenges) with your friends and family. Wrapping up with a VIP Party right in Straub Park to celebrate. Live Music & Dancing Race T-shirts Food Beer Garden* Southern Comfort Bar* For all questions contact Vicki Michaels, PIC Pirate in Charge vickimichaels@outlook.com
http://bostonbill.com
NICOLE DAVIS IRONMAN Team Psych Triathlon Club Co-Founder USAT Level I Coach
CONTACT INFORMATION Nicole@TeamPsychTri.com
2015-2016 Team Psych Must Do Races 8/8
5K for Brain Tumors
9/5
Crystal River Tri #3
10/18
Longleaf Triathlon – New Port Richey, FL
11/6
Richard’s Run
11/15
Rocket Man Triahtlon
2/13/16 Havana de triathlon Havana Cuba
This is the road trip or boat, or plane trip for 2016. We will be there as a team for this second annual event. Several of us are already registered. Please register soon before it sells out. July 30th is the first deadline to make travel arrangements before prices go up. I will be there a week for tours and professional meetings. Here are relevant links Triatl贸n de La Habana wants to be friends with you on Facebook.
www.info@triber226.com. Dear Mark. All event information in Ingl茅s can be found on our website www.triber226.com Information, tours, regulation, pictures, awards, delivery of numbers, registration forms, etc. Registration for the 2nd edition of the Triathlon de La Habana is now open. ITU official test calendar. IberoAmerican Triathlon Championship. Scoring for the Olympics. The appointment is for 13 and February 14, 2016. It will have three distances. - Long Distance (400 seats). - Middle Distance: (400 seats). - Sprint: (150 seats). As for his desire to make a tour of the factories that snuff can see with the Cuban agency CUBADEPORTES, they are responsible for accommodation in Havana for the days of triathlon, and its services is the former Follow us on facebook: https://www.facebook.com/triatlondelahabana Twitter: https://twitter.com/Triber226habana
Helmets for Havana -
A special project we will undertake to bring athletic gear to Childen of Cuba! Please contact Sara at sarlington82@gmail.com
Our Charities
1 Year FREE Membership Active Military & Families Afgan-Iraq Veteran MILITARY MEMBERSHIP That's right - it's FREE ! The Tampa Bay area Active Military and Family Memberships Package includes a Team Psych T-Shirt, Car Window Decal, Two Bike Flag-shaped Decals, (one for each side), Ten Body Tattoos, and membership card. One year active membership status. To be eligible you must be 1. Active Duty stationed in the Tampa Bay area 2. Be a Afgan-Iraq Veteran discharged from 2012 or later. 3. Attend a function; Team Psych Social, Open Water Swim or Team activity and fill out an application. This "Give Back" gift is made possible from our current paid memberships and sponsors.