Divine Movement

Club Registration Form

- Step 1 of 4

Athlete *

First

Last

Phone *

DOB: *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920

Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Additional Information

Gender? *MaleFemale

Age group *5-8 years9-10 years11-12 years13-14 years15-16 years17-18 yearsOpen Masters

Next

Parent/Guardian Information

Name *

First

Last

Email *

Phone *

Parent/Guardian Information

Name *

First

Last

Email *

Phone *

Next

Sprints

• 100 M
• 200 M
• 400 M
• 4X1 M Relay
• 4X4 M Relay

Distance

• 800 M
• 3000 M
• 2000 SC (w)
• 4X8 M Relay
• Steeple Chase

Hurdles

• 80 HH
• 100 HH
• 110 HH
• 20 IH
• 400 IH

Field Events

• Shot Put
• Javelin/Hammer
• Discus
• Pole Vault
• Long/Triple Jump
• High Jump

Next

Athlete Signature: *

Clear Signature

Parent Signature: *

Clear Signature

Date: *

USATF Member ID: (if applicable)

Make Payment