ORGANIZATIONAL/CLUB MEMBERSHIP APPLICATION

Organizational/Club Membership Application Organization Information

For Association Use Only Date Rec’d ____________________________ Check#___________Amt $_______________ # of Membership Years_________________ Membership Year(s) ____________________ Assoc. #_ ____________ Club ______________

*Organization Name________________________________________________ Use of "Olympics", "Team USA", or "USATF" are not permitted without permission from the USOC and/or USATF

Principal Location of the Organization

*City________________________________ *ST_ ________ Zip________________

HY-TEK Short Abbrev____________________ Approved By___________________________ Date Approved________________________

Check One: r New Membership r Renewal from Last Year r Renewal but not from Last Year r Update Multi-year Membership

*Website Address_ __________________________________________________ *Age Demographics

Type of Organization r Competitive Club r Event Organizer r Corporate r Other

r Youth r Masters r Open

Check all that apply

CONTACT INFORMATION

Sports r Track

r Field

r Road

r XC

r Mountain

r Ultra

*

$100 late fee; Renewal applications received after May 1st COMPETITIVE CLUBS ONLY

r Trail r Race Walking *Specified contact information will be posted on USATF website, www.usatf.org

All mail and e-mail correspondence from USATF will be sent to the following Contact Person ____________________________________________________________________________________ *Required to Access Club Management Area

Current USATF Individual Membership #_ _________________________________________________________

Shipping/Mailing Address_________________________________________________________________________ City_______________________________________________ ST_____________________ Zip______________________________ *Phone (Main)(

)_____________________________________ _ Phone (Alternate)(

*E-mail Address__________________________________________Fax ( Officers:

)____________________

)________________________________

President

Current USATF Membership #

Secretary

Current USATF Membership #

Other

Current USATF Membership #

Our organization, if accepted, hereby agrees to abide by the Rules and Regulations of USA Track & Field and to respect and enforce all decisions of USA Track & Field and its Associations.

Signature of Organization Officer Return this application form to:

PLEASE REGISTER OUR CLUB/ORGANIZATION FOR: r 1 YEAR r 2 YEARS r 3 YEARS r 4 YEARS

Fee = number of years X annual membership fee

*$100 late fee; Renewal applications received after May 1st COMPETITIVE CLUBS ONLY

NOTE: To maintain current contact information and to properly activate the liability insurance, clubs/organizations who apply for multi-year memberships must file a membership application, applicable coach’s registration forms, and club practice schedule each year.

Date For National office Use Only

Date Rec’d__________________________________________ Date Ent’d___________________________________________ Entered By_______________ CC $______________________ Check __________________ Amt. $_____________________