Nike Cross Regionals (NXR) Registration Form

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Downers South Distance Club

November 13-14 - Terre Haute, IN

https://nxrmw.runnerspace.com/eprofile.php?do=title&title_id=216&event_id=298

Athlete's Name (First and Last): *

Graduation Year: *

Athlete's Email Address: *

Athlete's Birthdate: *

YYYY

Athlete's Cell Number: *

Athlete's Street Address *

Athlete's City/State/Zip: *

Athlete's Dietary Restrictions/Health Concerns:

Note: Nike requests the name of one Emergency Contact with all Entries. The name listed below will be submitted with the athlete's entry.

Parent / Emergency Contact Name: *

Parent / Emergency Contact Phone Number(s): *

Parent / Emergency Contact Email Address: *

Alternative Contact Name:

Alternative Contact Phone Number(s):

Alternative Contact Email Address:

Athlete will ride to Terre Haute with the team on Saturday: *

Yes

Are you willing to drive a group of girls to Terre Haute and/or back? *

Yes

Maybe

If so, how many girls can you take? Please include your own athlete in the count - even if they are planning on going in another car.

Do you plan to reserve a hotel room for yourself?

Yes

Maybe

Clear selection

Saturday Dinner, everyone is welcome! Please indicate how many people will join the team for a pasta dinner near the hotel. Please only include family and athletes traveling separately from the team in this number. Cash payment will be collected at the restaurant.

At this time please print and complete the NXR Waiver, required for each participant. It can be found here: https://www.athletic.net/Partner/Nike/2021NXRWaiver.pdf, *

Waiver completed and ready to be returned with $80 payment.

Waiver completed and ready to be returned with $20 payment.

Required

Submit

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