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USATF-NE Membership Application

November 1, 2011 to December 31, 2012

To join USA Track & Field - New England, fill in the application below, print it, and send with a check to USATF-NE, P.O. Box 1905, Brookline, MA 02446-0016. Your number is assigned right away, and if you indicate an email address, the information will immediately be emailed to you. Membership cards are mailed from the National office and take 3-4 weeks to be sent, starting January 1.

The membership fee remains the same as 2011 (and the past 5 years). There is an adult discount when signing up _online_ for multiple years (see www.usatf.org)

Membership Fees for 2012 are:
$30 for Athletes 19 & older, Coaches, Officials, Supporters
$20 for Athletes 18 & younger
First Name: Date of Application:
Last Name:
Address:
Town/City: State:
Zip:
E-mail: Telephone:
Date of Birth:
Sex: FemaleMale U.S. Citizen: Yes No
Type: Athlete Coach Official Supporter Citizenship if not US:
Events:
Track & Field Long Distance Running
Racewalking
 Cross Country
Mountain/Ultra/Trail
Club Name: Club Number:
Please direct my additional contribution to
$ Youth Athletics $ Specific Program (list) $ Specific Program (list)

I certify that in accordance with the rules of the IAAF & USATF, I am eligible to compete in the indicated sport.

Signature: ______________________________     Date: _____________

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