Steele County Free Fair Street Vault MN 8/15/08

[mkolb1]

Steele County Free Fair Street Vault, Owatonna MN
Grand Stands

MEET REGISTRATION FORM Meet Fee: $30
8/15/08 11:33 a.m. 12:30 start
Today’s Date:
MUST HAVE USATF Registration No: (If you are under 18 yrs. old)
ATTENDEE INFORMATION
Attendee First Name: Attendee Last Name: Weight:

Address:
City: State: Zip:
Birth Date:
Age: Male or Female:
Current School Name

Year in School: Vault Coach: Best Vault In a Meet:
Any Medical Conditions (asthma, allergies, etc.):


INSURANCE INFORMATION
Policy Number:

Group Number Co pay: Providers Name:

EMERGENCY CONTACT INFORMATION
Relationship To Attendee:

Contact Number: Name of Friend/Family Member:

CLASS INFORMATION Circle the class you want to jump in:
College Women College Men High School Boys High School Girls
Open Women Open Men Masters 40 + Men Masters 40 + Women

Sign

Date
Attendee Signature/Parent or Guardian

Date
Make $30.00 check to :
Matt Kolb
You can bring it to the event. O.K. just let me know if you plan to attend. e-mail kolb@hickorytech.net

Questions, Call Coach Kolb 507-271-3626 or e-mail kolb@hickorytech.net
Elevation by Determination Pole Vault Camps, UCS Spirit Equipment and Tutoring