Pacific Northwest Ski Association

A Division of USSA

2009-2010 PNSA Competitor Contact Information Form

The following form is mandatory for all competitors (J3 - A). The PNSA office needs this information on file so that we can reach athletes/parents by phone, e-mail, and snail mail throughout the season.

Complete the contact information form online (preferred), or print the form and mail it with
your medical release. Medical Release Form (pdf file)

Mail forms to: PNSA...... 2671 Flowery Trail Rd......Usk, WA 99180-9740

First Name	Last Name:	Email:
Birthdate:	USSA ID:	FIS ID:
Address:		City:
State:	Zip:	Team:
Phone:	Cell phone:
Dad's Name	Dad's Home Phone	Dad's Work Phone
Dad's Cell Phone	Dad's Email	Dad's Address
Dad's City	Dad's State, Zip
Mom's Name	Mom's Home Phone	Mom's Work Phone
Mom's Cell Phone	Mom's Email	Mom's Address
Mom's City	Mom's State, Zip
Coach:	Coach Phone:	Coach Email: