USCAA National Membership Application
You must be a member of the USCAA to compete in USCAA Events
$15 online,    $20 mail-in/fax form,    $25 at the event
* - indicates a required field.

Membership Information
  Create a new membership for calendar-year(s) starting in
Name*
  first middle (optional)        last (surname)  
Gender*    male     female (mon/day/yr) Birthdate*
I am a*    team captain    team coordinator    athlete    supporter
Address*
 
 
  city state/province zip/postal code      country
Phone  
  home / cell work  
Email
Type*    New Membership    Renewal from a previous year
Team* employee   retiree
contractor   alumni
other
    if other      
Employer    ( if different than team)
  I would like to help: choose or plan a future Nationals
recruit more teams
with sponsorship
 
Create a login to access certain features of the USCAA website (or create one online later):
Username: Password:
Hint:
(This hint will be emailed to you if you forget your password)
 
Waiver of Liability


In consideration of my acceptance of this form and USCAA membership application, I hereby, on behalf of myself, my heirs, executors, administrators and assigns; waive, release and hold harmless the USCAA, event organizers and officials, representatives of the host city and their directors, managers, officers, employees and agents from any and all claims for damages and or injuries arising out of participation in and travel to and from any USCAA associated event.

  You may receive mailings (not emails) from USCAA affiliates about races, products, or events.
Your email will not be given out. If you prefer not to receive these mailings, send a letter stating this to:
USCAA, Attn: Mailing Preferences, 11 Nimrod Road West Simsbury, CT 06092

If mailing this form, mail it to the address above.