Registration Form

ATHLETE INFORMATION

First Name
Middle Name
Last Name
Address
City
State
Zip Code
Telephone(Home)
Telephone(Work)
Are you a returning member?   Yes |  No

Are you a first-time USATF athlete?   Yes | No
Personal Information:
Birth Date - -

Gender:  Male | Female
Are you a U.S. Citizen?  Yes | No

Ethnic Background
Are you Hispanic or Latino?   Yes |  No |  Decline to answer

What is your race? (Please select one or more races)

 American Indian/ Alaska Native
 Asian
 Black / African American
 Native Hawaiian / Pacific Islander
White / Caucasian
Other
Decline to answer



PARENT INFORMATION

First Name(Mom)
Last Name(Mom)
First Name(Dad)
Last Name(Dad)
Phone(Mom)
Phone(Dad)
Email(Primary)
Email(Secondary)



EMERGENCY CONTACT

First Name
Last Name
Relationship
Telephone



Special Requests