Name:_______________________________________________________________________

Addres:______________________________________________________________________

Cit:_________________________________ State:________ Zip code:___________________

Home Phone:_______________________Work Phone _______________________________

Email Address:________________________________________________________________

Occupation or School if studen:___________________________________________________

 Gender: circle Male or Female

 Age:______ Date of birth:________State or Country of birth:_________________________

Category:

 Track & Field Sprints/Hurdles:_________________________________________________

 Track & Field Middle Distance: ________________________________________________

 Track & Field Distance:_______________________________________________________

 Field & Track Jumps/Throws:__________________________________________________

 Road Racing:_______________________________________________________________

 Marathon/Triathlon:__________________________________________________________

 Cross Country:_____________________________________________________________

 Other/Fitness: _____________________________________________________________

Tell us how you heard about us: _________________________________________________