On-Line Application

Personal Information

Name
Date of Birth
Sex	Male Female

Contact Information

Parent/Guardian Name
Work Phone
Home Phone
Emergency Phone
E-mail
Address
City
State
Zip

Choose one of the following Membership Options:

New Member Renewal New Family Family

Choose one of the following Uniform Top options:

Youth Small Youth Medium Youth Large Adult Small Adult Meduim Adult Large XLarge XXLarge XXXLarge

Choose one of the following Uniform Bottom options:

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Xlarge XXLarge XXXLarge

Enter your Event or Sport in the space provided below. (I.E. 100m dash)

Enter your Event or Sport in the space provided below.

Enter your Event or Sport in the space provided below.

Enter your Event or Sport in the space provided below.

Waiver

All club of members should be in good physical condition.  The Flight101 Track Club does not assume responsibility for any injuries that might occur. 

In consideration of the acceptance of this membership, I waive, for myself, my heirs and assigns, all claims of damages which I might have against  the Flight101 Track Club as a result of any and all injuries which might be received during any Flight101 Track Club sponsored activity, practice, training or contest . 

In addition, I agreed to the  rules and regulations as set forth by the Flight101 Track Club. 

I agree                        I disagree