NAME: __________________________________________________________

AGE: _______        DATE of Birth: ____________________

ADDRESS: ___________________________________________________________

CITY: ______________________    STATE: _____________       ZIP CODE: _________

WORK PHONE: _________________           HOME PHONE: _________________

CELL PHONE: __________________   EMAIL: _______________________________________

TRACK and FIELD   EVENTS:_____________________________________________________________________

RELAY EVENTS: ______________________________________________________

Emergency contacts: ______________________________________________________

A physical is required every year at the athlete own expense. Date of last Physical:

NOTE: CLUB DUES are $130.00 PER YEAR.  All DUES SHALL BE RECEIVED BY FEBRUARY 15, 2007. The club dues cover the period form January to December of each Year. Make check/money order payable to: Sherman Weatherspoon, or Thomas Jones.  Mail application and dues to: Sherman Weatherspoon, 11901 Bracken Court,  Bowie, Maryland  20720.

WAIVER: In consideration of the acceptance and joining the Maryland Masters Tack and Field Club, I, intending to be legally bound for myself, my heirs, my executors and administrators, waive, release and discharge any and all rights and claims which I may have or which hereafter may accrue against the Maryland Masters Track and Field Club, or any of the club officers, coaches, sponsors, all assisting organizations and individuals from all claims of damage actions, injury or death received in any manner before, during or after participation with the Maryland Masters Track and Field Club. I also agree to abide by the Maryland Masters Track and Field by laws. I certify that I am physically fit to participate in all Maryland Masters Track and Field events and practices.