TEAM NODAK SUMMER VAULT CLUB
TEAM NODAK TRACK CLUB
2006 USATF DAKOTAS ASSOCIATION
Schlanser Track Complex - Fargo, ND 58105
(check one)
Girl
(check one)
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TEAM NODAK SUMMER VAULT CLUB TEAM NODAK TRACK CLUB |
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| ATHLETE NAME: | ______________________________________________ | |
| BIRTH DATE: | ______________________________________________ | |
| GAURDIAN NAME: | ______________________________________________ | |
| HOME ADDRESS: | ______________________________________________ | |
| HOME PHONE #: | ______________________________________________ | |
| CELL PHONE #: | ______________________________________________ | |
| EMAIL: | ______________________________________________ | |
| CITY: | ______________________________________________ | |
| STATE: | ______________________________________________ | |
| ZIP: | ______________________________________________ | |
| VAULT PR: | ______________________________________________ | |
| HIGH SCHOOL: | ______________________________________________ | |
| GENDER: (check one) |
Boy
Girl |
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| AGE GROUP: (check one) |
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| Club fees are $60 for the summer - Make checks payable to: TEAM NODAK | ||