2019 Mid-Atlantic Junior National Team
2019 Mid-Atlantic Junior National Team Trip Info
Athlete First Name *
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Athlete Last Name *
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Athlete Date Of Birth *
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Racing Division
Athlete Cell Phone Number
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Athlete E-mail
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Athlete USSA Membership Number *
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Athlete NYSSRA NORDIC Membership https://www.skireg.com/nyssra-nordic-membership-18 *must be a member of NYSSRA Nordic if not Join !
Athlete Affiliation to be used on results I.E Club or High School
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Athlete USSA Club
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Athlete High School
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Athlete Town of Residence
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Postal Code
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Athlete State of Residence
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Athlete Arrival Date
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Athlete arrival time and flight number
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Athlete departure date
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Athlete departure time and flight number
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Traveling with Parent or Coach
Athlete T-Shirt Size ( Men's Sizing )
Athlete Allergies if NO leave blank
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Athlete Dietary Restrictions if NO leave blank
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Athlete Medical Condition if NO Leave Blank
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Insurance Carrier
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Insurance Policy #
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Parents or Guardian Name
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Father Cell Phone
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Mother Cell Phone
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Father E-mail
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Mother E-mail
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Emergency Contact
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Emergency Contact Cell
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Parents attending races in Anchorage ?
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