West Regional Entry Form
June 23, 2001
San Diego State University
Name (First Last) __________________________________________________
Sex (circle one) M / F
Age on 6/23/2001 __________________________________________________
Birthdate (mm/dd/yy) __________________________________________________
USATF Registration # __________________________________________________
Street Address __________________________________________________
City State ZIP __________________________________________________
E-mail address __________________________________________________
Club Affiliation __________________________________________________
Events (circle)
100m 80/100/110m Hurdles 4x100m Relay
200m 300/400m Hurdles 4x400m Relay
400m 2000/3000m Steeplechase 4x800m Relay
800m
1500m 5000m Racewalk
5000m
High Jump Shot put
Pole Vault Discus throw
Long Jump Hammer throw
Triple Jump Javelin Throw
Registration Fee $20
Entry Fee ($5/event) ___
Total ___
Make checks to San Diego Senior Sports Festival
Mail to San Diego Senior Sports Festival
PO Box 84202
San Diego CA 92138-4202
Waiver In consideration of your accepting my entry, I,
intending to be legally bound, do hereby for
(Must be signed myself, my heirs, executors and administrators,
for entry to be waive and release forever any and all rights,
accepted) claims or damages I may accrue against
USA Track and Field, SDSU, San Diego Senior Sports
Festival and all sponsors of this meet, their
successors, representatives and assigns, for any
and all injuries suffered by me while traveling to
and from the meet and while competing in the meet.
Signature __________________________________________________
Date _________________