Missouri Western Athletics - MWSU_VIVATURE_INFO_SHEET_docx.pdf

Vivature Student Athlete Information First Name: Last Name: Date of Birth: Gender:

MALE

or

FEMALE

Address:____________________________________________________ CITY STATE

_________ ZIP

E-MAIL:_____________________________________________________________________ MWSU G#: Date enrolled at MWSU: SPORT:_______________________________________________________________________________ Class Year (Circle one):

FRESHMAN JUNIOR

REDSHIRT FRESHMAN SENIOR

Missouri Western State University Sports Medicine 4525 Downs Drive, St. Joseph, MO 64507 Phone: (816) 271-4597 Fax: (816) 271-4186 www.gogriffons.com

SOPHMORE 6TH YEAR SR