2006 USATF NE Membership Application

To join USATF NE, fill in the application below, print it, and send it with a check to:
USATF NE, P.O. Box 1905, Brookline, MA 02446.
Allow 2-3 weeks to receive your card.

Membership Fees: $15 for Athletes 19 & older After September 1
$15 for Athletes 18 & younger; $20 for Coaches, Officials, Fans

Application Date:
First Name:
Last Name:
Address:
Town/City:
State:
Zip:
Telephone:
E-Mail:
Date of Birth:
Age:
Sex:
U.S. Citizen:	Yes No
Type:	Athlete Coach Official Parent
Events:	Track & Field Long Distance Running Racewalking Cross Country Ultra
Club Number:	235
Club Name:	PR Moose Milers Racing Team
Please direct my additional contribution ($10, $20, $50, other) to	$___ Track & Field $___ Junior Olympics $___ Cross Country $___ Road Racing $___ Race Walking $___ General Fund

I certify that in accordance with the rules of the IAAF & USATF, I'm eligible to compete in the indicated sport(s).

Signature: ______________________________