CLUB NAME _____________________________________ AAU CLUB # _________________________ 

HEAD COACH_____________________________________________________

ADDRESS _____________________________________________ PHONE # (_____) ______ _______ 

CITY _______________________________________________ STATE ____ ZIP CODE ___________ 

PLEASE SUBMIT A DIFFERENT REGISTRATION FORM FOR EACH GENDER AND AGE GROUP!

CIRCLE GENDER: M F AGE GROUP: Prim - SubB - Bant - SubM - Midg - SubY - Yth - Int - Young M/W 

       ATHLETE NAME        BIRTHDATE (M/D/Y)                  EVENTS

1. ______________________  _____/_____/_____    _____________________________________ 

2. ______________________  _____/_____/_____    _____________________________________ 

3. ______________________  _____/_____/_____    _____________________________________

4. ______________________  _____/_____/_____    _____________________________________

5. ______________________  _____/_____/_____    _____________________________________

6. ______________________  _____/_____/_____    _____________________________________

7. ______________________  _____/_____/_____    _____________________________________

8. ______________________  _____/_____/_____    _____________________________________

9. ______________________  _____/_____/_____    _____________________________________
 
10. _____________________  _____/_____/_____    _____________________________________

ENTRY FEE & REGISTRATION INFORMATION 

$5.00 Per Athlete - If received before Wednesday 11:59 pm, prior to Saturday meet. 
$7.00 Per Athlete - Receipt after Wednesday and before Thursday 11:59 pm.
No race day registration.
  
On behalf of the member(s) 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.  All athletes 
listed above are registered AAU members.  As proof of membership, I have attached my
club's membership roster printed from http://application.aausports.org/aausports/.  
Also, the hosting club is not responsible for the loss of personal items in connection 
with said event. 

______________________________________________ _________ 
(Signature of Head Coach)                      Date