Questions in red are required for submission.

* 1. Name

* 2. Email

* 3. Phone

* 4. Address

* 5. Age

* 6. DOB

* 7. Sex

Male  Female

This is required so that we may include you on our official USAT club roster.   8. USAT number

9. Are you a (check all that apply)

Triathlete  Xterra  Duathlete  Runner  Road Cyclist  Mountain Bike  Cyclo Cross  Other

10. Are you applying for our...

Elite team   Junior Elite  Xterra  Age group team  Coaching Scholarship Program

11. Please breifly describe your competetive experience. Include placements, awards, and how long you have been competing.

12. Please tell us how you can promote our services and our team sponsors products and services

13. Do you compete mainly on the local level or travel to races?

14. What is your main goal for next season? Please list a tentative race schedule.

15. What is your ulimate or "dream goal" as an athlete?

16. Do you currently have a coach?

Yes  No

17. Are you currently sponsored? If yes please list.

No  Yes