NEBRASKA ASSOCIATION
		 USA TRACK & FIELD

INDIVIDUAL ENTRY FORM FOR YOUTH MEETS


NAME OF MEET ___________________________________________

LAST NAME __________________________________

FIRST NAME __________________________________

GIRL ___________ or BOY __________

FULL DATE OF BIRTH   ______ / ______ / ___________

USATF MEMBERSHIP # ________________________

CLUB NAME ___________________________ or UNATTACHED ______

ATHLETE'S HOME ADDRESS ____________________________________________

ATHLETE'S CITY, STATE, ZIP _________________________________________________

EVENT #1 ___________________________   Seed Time/Mark ______________

EVENT #2 ___________________________   Seed Time/Mark ______________

EVENT #3 ___________________________   Seed Time/Mark ______________

(13-14, 15-16, and 17-18 only)
EVENT #4 ___________________________   Seed Time/Mark ______________


NAME OF PERSON SUBMITTING ENTRY FORM

______________________________________________________________________________

E-MAIL ADDRESS ______________________________________________________________

PHONE __________________________


PAYMENT MUST BE SENT WITH FORM OR ENTRY WILL NOT BE PROCESSED.  NO EXCEPTIONS!