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2009 AAU Track and Field
Minnesota District Qualifier
Individual Entry Form

Name Michael D. Carter, Jr.

Address 2061 Wallingford Lane

City

Woodbury

State/Zip Woodbury, 55125

_____________

Phone 651-730-8055

Email:ccarter2 9@comcast.net

All of the above information is required; the address and phone information must be that of the

athlete\u2019s legal guardian. Club contact information will not be accepted. No Exceptions.

AAU Membership Number:________ _____

Gender (circleone)

Female

Male

Date of Birth

02/06/1999

Club Status (checkone)

X attached (club name)Team Woodbury

___ unattached

Division (checkone)

____Primary (born in 2001/after)

____Sub Bantam (born in 2000)

____Bantam (born in 2000)

____Sub Midget (born in 1998)

____Midget (born in 1997)

____Sub Youth (born in 1996)

____Youth (born in 1995)

____Intermediate (born in 1993/94) ____Young (born in 1991/92) *

*Exception: Athletes who do not turn 19 before the last day of the National Meet, August 1, 2009

are eligible to compete in the Young Men or Young Women Division through that meet.

Events:

1st Event_ _________________

2nd Event__________________

3rd Event_ _________________

4th Event_ _________________

Proof of Age: You are not required to submit proof of age documentation with this entry; however it

should be with you at the meet in case of an age eligibility protest.

Entry Fee:

$20 for all age groups

Payable to: Track Minnesota

$20 fee for returned checks

Entry by mail: Send form and payment

For online registration:

to:

www.ptentry.com/5/

Minnesota District Qualifier

Bring fee to meet (must be cash or

C/O Jack Mayeron

cashier\u2019s check)

5580 Old Market Road

No IOU\u2019s \u2013 Must be paid in full

Shorewood, MN 55331

to compete

All entries must be received by 3:00 pm June 10, 2009.

The above named participant (and the participant\u2019s parent/guardian if participant is a minor) has (have) requested registration of the participant in the AAU
Minnesota District Track and Field Meet. In consideration of such registration, the right of the participant to compete in the AAU Minnesota District Track
and Field Meet and the use by the participant of the sponsoring agency\u2019s facilities and equipment, the participant (and the parent/guardian) each
acknowledge that the participant will be competing in the AAU Minnesota District Track and Field Meet and the sponsoring agency\u2019s facilities at the
participant\u2019s sole risk and the participant, on his or her own behalf and the on the behalf of his or her heir, executors, administrators and assigns hereby
release, discharge and agree to hold harmless Northstar Youth Club and its officers, Independent School District 196 and Eagan High School, the Northstar
United Track Team, AAU MN, Track Minnesota and the volunteer or paid meet officials. I/we certify that the information on this participation form is correct.

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