Pay test Membership Form (#20)Δ First Name / PrénomNameLast Name / nom de familleAddressAddress Line 1Address Line 2CityCountry Canada USA OtherProvince- Select -AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonState- Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip CodePostal CodeOther Postal CodeEmailPhone/MobileBirth DateGender Female MaleMens Age GroupAge GroupM30 (30-34)M35 (35-39)M40 (40-44)M45 (45-49)M50 (50-54)M55 (55-59)M60 (60-64)M65 (65-69)M70 (70-74)M75 (75-79)M80 (80-84M85+Womens Age GroupAge GroupW30 (30-34)W35 (35-39)W40 (40-44)W45 (45-49)W50 (50-54)W55 (55-59)W60 (60-64)W65 (65-69)W70 (70-74)W75 (75-79)W80 (80-84)W85+Status Canadian Citizen / citoyen canadien Permanent Resident / résident permanentMembership New Member / Nouveau membre Continuing Member / Membre permanent Club Name / nom du club Role / rôle Athlete / athlète Coach / entraîneu IWF 1 IWF 2 Level 3 Level 42024 Membership PaymentAmount: $65.00Pay with Card (Stripe)No payment items has been selected yetSubmit Form