Aau Entry Form

2009 AAU Track and Field Minnesota District Qualifier Individual Entry Form

Name Michael D. Carter, Jr.

Address 2061 Wallingford Lane

City

State/Zip Woodbury, 55125_____________

Woodbury

Phone 651-730-8055

Email: [email protected]

All of the above information is required; the address and phone information must be that of the athlete’s legal guardian. Club contact information will not be accepted. No Exceptions.

AAU Membership Number: _ Gender (circle one)

____________

Female

Male

Date of Birth

02/06/1999

Club Status (check one) X attached (club name)Team Woodbury ___ unattached Division (check one) ____ ____ ____

Primary (born in 2001/after) Sub Midget (born in 1998) Youth (born in 1995)

____ ____ ____

Sub Bantam (born in 2000) ____ Midget (born in 1997) ____ Intermediate (born in 1993/94) ____

Bantam (born in 2000) Sub Youth (born in 1996) Young (born in 1991/92) *

* Exception: Athletes who do not turn 19 before the last day of the National Meet, August 1, 2009 are eligible to compete in the Young Men or Young Women Division through that meet. Events: 1st Event __________________ 3rd Event __________________

2nd Event __________________ 4th Event __________________

Proof of Age: You are not required to submit proof of age documentation with this entry; however it should be with you at the meet in case of an age eligibility protest. Entry Fee:

$20 for all age groups

Payable to: Track Minnesota

Entry by mail: Send form and payment to: Minnesota District Qualifier C/O Jack Mayeron 5580 Old Market Road Shorewood, MN 55331

$20 fee for returned checks

For online registration: www.ptentry.com/5/ Bring fee to meet (must be cash or cashier’s check) No IOU’s – Must be paid in full to compete

All entries must be received by 3:00 pm June 10, 2009. The above named participant (and the participant’s parent/guardian if participant is a minor) has (have) requested registration of the participant in the AAU Minnesota District Track and Field Meet. In consideration of such registration, the right of the participant to compete in the AAU Minnesota District Track and Field Meet and the use by the participant of the sponsoring agency’s facilities and equipment, the participant (and the parent/guardian) each acknowledge that the participant will be competing in the AAU Minnesota District Track and Field Meet and the sponsoring agency’s facilities at the participant’s sole risk and the participant, on his or her own behalf and the on the behalf of his or her heir, executors, administrators and assigns hereby release, discharge and agree to hold harmless Northstar Youth Club and its officers, Independent School District 196 and Eagan High School, the Northstar United Track Team, AAU MN, Track Minnesota and the volunteer or paid meet officials. I/we certify that the information on this participation form is correct.

2009 AAU Track and Field Minnesota District Qualifier Individual Entry Form

Cheryle R, Carter

06/05/2009

Signature (Athlete or Minor Guardian)

Date