INDIVIDUAL REGISTRATION FORM


NAME __________________________________________ AAU CARD # _________________________ 

ADDRESS _____________________________________________ PHONE # (_____) ______ _______ 

CITY _______________________________________________ STATE ____ ZIP CODE ___________ 

CIRCLE YOUR GENDER: 

Male Female

BIRTHDATE (MM/DD/YY): _____/_____/_____ 

CIRCLE AGE GROUP: 

Primary - SubBantam - Bantam - SubMidget - Midget - SubYouth - Youth - Intermediate - YM/YW 

EVENTS IN WHICH YOU WILL BE COMPETING:  

1. ________________________________________________ 

2. ________________________________________________ 

3. ________________________________________________ 

4. ________________________________________________ 
  
ENTRY FEE & REGISTRATION INFORMATION 

$5.00 Per Athlete - If received by Wednesday 11:59 pm prior to scheduled meet. 
$7.00 Per Athlete - Receipt after Wednesday and before 11:59 pm Thursday.
No raceday registration please.
  
On behalf of the member listed above, I hereby waive any and all claims for damages
I may have against the sponsors, hosts, and individuals associated with the event,
for any and all injuries suffered by me in connection with said event.  Also, none 
of the above are responsible for the loss of personal items in connection with 
said event. 


______________________________________________ _________ 
(Signature of Parent or Guardian)              Date 

For Mailing Address refer to www.arkansasaau.org