Application Form

2009 Illini Heat Track Club Application Form

Athletes Name:

Street Address:

Home Phone:

City:

Zip Code:

Parent/Guardian Work Phone:

Parent/Guardian Cell Phone:

Emergency Contact:

Parents Email:

Date of Birth:

I plan on attending all club practices unless an emergency arises. If no, please use the following space to list any conflicting (or potentially conflicting) activities which would prevent you from attending practices. Included additional sports activities and whether or not these activities would take precedence over track club.

What are your personal records (PRs) , if applicable?

What are your personal goals for this season?

Meet Selection

Will you be attending this meet?

Dec 12: Junior Olympic National Meet, Reno, NV

Nov 28: Regional Meet, Terre Haute, IN

Print 2 copies of this page before hitting SUBMIT button.

Keep one for your files and mail one with membership package.

Nov 14: State Meet, Plainfield - Youth, Midget and Bantam meet only

Parent/Guardian Names:

Will you be attending this meet?

Nov 8: Fairview Park, Decatur - Youth, Midget and Bantam meet only