NEBRASKA ASSOCIATION USA TRACK & FIELD INDIVIDUAL ENTRY FORM FOR YOUTH MEETS NAME OF MEET ___________________________________________ LAST NAME __________________________________ FIRST NAME __________________________________ GIRL ___________ or BOY __________ FULL DATE OF BIRTH ______ / ______ / ___________ USATF MEMBERSHIP # ________________________ CLUB NAME ___________________________ or UNATTACHED ______ ATHLETE'S HOME ADDRESS ____________________________________________ ATHLETE'S CITY, STATE, ZIP _________________________________________________ EVENT #1 ___________________________ Seed Time/Mark ______________ EVENT #2 ___________________________ Seed Time/Mark ______________ EVENT #3 ___________________________ Seed Time/Mark ______________ (13-14, 15-16, and 17-18 only) EVENT #4 ___________________________ Seed Time/Mark ______________ NAME OF PERSON SUBMITTING ENTRY FORM ______________________________________________________________________________ E-MAIL ADDRESS ______________________________________________________________ PHONE __________________________ PAYMENT MUST BE SENT WITH FORM OR ENTRY WILL NOT BE PROCESSED. NO EXCEPTIONS!