Become a Member

PTOEC Membership Form

* Indicates required field

Athlete's Name *

First

Last

Date of Birth *

T-Shirt Size *

Primary Contact's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Name of Previous Special Olympics Agency *

Phone Number *

Email *

Would you like a PTOEC representative to contact you with additional information? *

Yes No

Is PTOEC able to use the athlete's photo on their website and other publications? *

Yes No

*Please proceed to the "Pay Dues" page to make your $50 membership fee payment, or mail check (made out to PTOEC) to PO Box 23424 Belleville, IL 62223-0424, to complete your registration.

Submit Registration