USA-Distance


On-line Contact Info Registration

A key function of this page is to obtain contact information from you, so that Men's and Women's Development will be able to contact you directly concerning their projects and competitive opportunities. Trust us when we tell you that, often, it is a major prolem trying to track people down.

Please take a few short moments to fill out this simple, on-line form, and BOOKMARK this page now, so that you can use it again if you move.

Female athletes will also have the option of using this form to apply for consideration for the European trip for summer '98, sponsored by Women's Development.

In the form you have two options regarding the privacy of your contact information: a) you can choose to keep your contact information private. If you choose this option, your contact information will be given only to members of Men's and/or Women's Development.... or b) you can choose to have your contact information listed on the web page with other athletes. By selecting this option, other athletes will have access to your contact info and will know how to reach you. Note that if you choose to list your contact info on this web page, you can later have it removed by sending an e-mail to us at chapmar@phscare.org

When you are done with the form, simply hit "SEND" and it will automatically be sent to us.

USA Distance Contact Information Registration

Name:

Gender

Male
Female

E-mail address (leave blank if you do not have one):

Current address

Street address (include apt#, if necessary):

City: State: Zip:

Home Phone (use this style xxx-xxx-xxxx):

Work Phone (if none leave blank):

Fax number (if none leave blank):

Coach's Information

Coach's name:

Coach's street address (include apt#, if necessary):

City: State: Zip:

Coach's home phone (use this style xxx-xxx-xxxx):

Coach's work phone (if none leave blank):

Coach's fax number (if none leave blank):

Number of years you have been with this coach:

Other Information

What is your club affiliation, shoe sponsor (or unattached):

Where did you/do you attend college:

Best Marks

(Completing this section is optional, however, it allows Development to better "track" each athlete and is required for the application to Women's Development for the European trip opportunity)

Lifetime best PR's

Please select your primary event(s)from the list on the left, and enter your lifetime best PR for that event in the box next to it.

Time: Site: Date:

Time: Site: Date:

Time: Site: Date:

Time: Site: Date:

97-98 Best Performances (include road races)

Time: Site: Date:

Time: Site: Date:

Time: Site: Date:

Time: Site: Date:

Finally.....

How do you want us to handle your contact information?
[Women only] Would you like to be considered for the Summer '98 European trip, sponsored by Women's Development?
Yes
No

(Note: when you hit SEND, it may take up to a minute before the confirmation page is loaded, so please be patient.)