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2020 Mid-Atlantic Junior National Team
2020 Mid-Atlantic Junior National Team Trip Info
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* Indicates required question
First name
*
Your answer
Last name
*
Your answer
correct pronunciation
Your answer
Athlete USSA License #
Your answer
Athlete Date Of Birth
*
MM
/
DD
/
YYYY
Gender
Male
Female
Clear selection
Racing Division
Mid-Atlantic
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Racing Division
U16 Male
U16 Femaile
U18 Female
U18 Male
U20 Female
U20 Male
USSA Club Name
Your answer
Club Team Affiliation
Your answer
Non-Quota Pre-Qualify
NO
Yes
Clear selection
No Charge Pre Qualify
NO
Yes
Clear selection
High School Name
Your answer
College Name
Your answer
Hometown
Your answer
Address
Your answer
State
Your answer
Postal Code
Your answer
Country
Your answer
Athlete Cell Phone Number #'s only
Your answer
Athlete E-mail
Your answer
Emergency Contact Name
Your answer
Emergency Contact Relationship
Your answer
Emergency Contact Phone Number #'s Only
Your answer
Medical Conditions ( pre-existing )
Your answer
Athlete NYSSRA NORDIC Membership *must be a member of NYSSRA Nordic if not Join !
https://www.skireg.com/5752
Yes
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Athlete Arrival Date
MM
/
DD
/
YYYY
Athlete arrival time and flight number
Your answer
Athlete departure date
MM
/
DD
/
YYYY
Athlete departure time and flight number
Your answer
Traveling with Parent or Coach
Yes
No
Clear selection
Athlete T-Shirt Size ( Men's Sizing )
XS
S
M
L
XL
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Athlete Allergies if NO leave blank
Your answer
Athlete Dietary Restrictions if NO leave blank
Your answer
Insurance Carrier
Your answer
Insurance Policy #
Your answer
Parents or Guardian Name
Your answer
Father Cell Phone
Your answer
Mother Cell Phone
Your answer
Father E-mail
Your answer
Mother E-mail
Your answer
Parents attending races in Minneapolis?
Yes
No
Clear selection
Team Meal Plan ( enter yes or no ) if parents are using the meal plan in addition to the athlete please make note of that below. approximant cost $290
*
Your answer
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