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| Step 1 of 2 - Team Registration You are considered Club Contact for this Team Registration... |
Club Contact's First Name
| Last Name
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Address 1
| Address 2
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City
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State / Province
Use 2 digit code for US and Canada
otherwise, leave blank.
![[US Flag]](../images/flags/smUSA.gif) ![[Canadian Flags]](../images/flags/smCanada.gif) | Country (only if outside of the U.S. and Canada)
Leave blank if address is within US or Canada. |
Zip / Postal Code
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Primary Phone Number
Required... please provide your primary number. | Other Phone
Optional... provide an alternate phone number. |
Email Address
Participant's active Email Address... check for accuracy. |
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Club
Required... select your club affiliation from this drop-down list. |
Title of Club Contact
Required... as club contact, please provide your title, such as Club Director, or Team Captain, or Team Coach, etc. |
Will You be Participating in this Event?
Optional... as club contact, will you be participating as a runner with your team in this event? By default, we're assuming that you will participate with this team.
If No... choose response from drop-down selector.
If Yes... leave selector blank, and provide your Date of Birth & Sex below. |
Club Contact's Date of Birth
Format: YYYY-MM-DD | Sex
Gender: M for Male, F for Female. |
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Total Number of Team Members for this Team (2 minimum -to- 9 maximum)
Required... total number of members for this team. Count yourself (as Club Contact) plus the number of runners that will compete for your team in this event.
Example... Let's say this team is made up of you, plus seven runners.
You + 7 = 8
Note... $20.00 registration fee per teammate. |
Waiver
Liability Waiver: (Must be signed by all participants) In consideration of the acceptance of my application for registration
In the Illinois Club Cross Country Championships, I hereby waive and release for myself, my heirs, executors, and administrators any and all rights and claims for injuries, damages and/or losses, to include loss of life, which I may have against the sponsors/ cosponsors and their agents, employees or representatives for any and all activities connected with the Club Cross Country Championships.
I warrant and represent that I am in good physical health and condition, and I am physically able to compete in the events I have selected. I know of no physical restrictions whatsoever which would prevent my participation in these events. Please Note: For promotional purposes photographs may be taken of participants.
Unfortunately, we are unable to issue refunds for any reason.
By signing this, you agree to all of the terms above. Agree to waiver by checking here.By agreeing to this waiver you submit to the terms and conditions as set forth by this event and certify that you have provided true and accurate information as requested through this registration process. |
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