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Evansville Speedsters 2010 Dues, Uniforms, and Events Level 1 – Practice Only or Local Meets only, No team shirt or shorts Team Dues - $10 Level 2 – Local Meets Only, team shirt and shorts A: Team Dues - $10 – returning member with uniform B: Team Dues - $25* – new member or you need a new uniform Shirt Size ... Circle One ... YS

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Shorts Size … Circle One … YS YM YL S M L XL ____ Level 3 – Local, State, and other meets, Team shirt and shorts required USA Track and Field (USATF) Dues - $20 USATF # ________________ USATF # is required for State, Regional, and National meets Online USATF Membership Registration: https://www.usatf.org/membership/application/ A: Team Dues - $65 returning member with a uniform B: Team Dues - $80* for new member or you need a new uniform Shirt Size ... Circle One ... YS

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Shorts Size … Circle One … YS YM YL S M L XL ____ Name ____________________________________________________________ Circle One  Male / Female Dues Paid $__________ Level _____ Rec’d by: __________________________ * - If you have a pair of plain black running shorts already, it will be $5 less … $20 for Level 2 and $75 for Level 3. _____ Please list the events you want to participate in: Events : ____________

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Evansville Speedsters Track Club ATHLETE REGISTRATION FORM Athlete Name: ______________________________________

DOB: ______________

Street Address: _____________________________________

City: ______________

State: ______

ZIP: ________________

Home Phone: _______________

Cell Phone: _______________ Email : _______________________________________ School: __________________________________

Grade: _____________________

HEALTH INSURANCE INFORMATION Health Insurance Provider: _________________________________________________ Group Number:_______________________ Phone Number: ______________________ Insured Name: __________________________________________________________ Health Concerns: _________________________________________________________ Any Known Allergies: _____________________________________________________ PARENT / GUARDIAN INFORMATON Mother’s Name: _______________________ Father’s Name: _____________________ Work Phone: _________________________ Work Phone: _______________________ Cell/Pager: ___________________________ Cell/Pager: _________________________ Email: _______________________________ Email: ____________________________ By signing below, I a prospective member of the Evansville Speedsters Track Club, agree to abide by the rules of the Speedsters, the USATF bylaws,, Operating Regulations, and competition rules for my level and category of membership,

__________________________________________ Signature of Parent or Guardian if athlete is under 18 years old

Date: ______________________


EMERGENCY CONTACT INFORMATION Name: _______________________________ Relationship: ______________________ Home Phone: _________________________ Work Phone: ______________________


Speedsters Registration  

Registrations and Uniforms.

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