NAME ______________________________________________M or F (circle)

ADDRESS_____________________________________________________

CITY___________________________STATE ____________

ZIP CODE____________

PHONE: (H) ________________________(W)_____________________________

E-MAIL ADDRESS___________________________________________________

EVENT(S) & PERSONAL BESTS

______________________________________________________________________

Print, complete, detach, and return this form along with $30.00 yearly dues, payable to

CLUB BALLARD ATHLETICS, P.O. Box 70601, Seattle, WA. 98107-0601

Telephone: 206/499-4329

FAX (206) 725-3662

AS A CONDITION OF MEMBERSHIP, I HEREBY AGREE TO ABIDE BY THE PRINCIPLES OF USA TRACK & FIELD, AND OF SPORTSMANLIKE CONDUCT WHEN ENGAGING IN CLUB ACTIVITIES AND COMPETITIONS.

SIGNATURE__________________________________________________________