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 2009 2008 2007
Name*
	first	middle (optional)	last (surname)
Gender*	male     female	(mon/day/yr) Birthdate*	month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 18 19 20
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*	Please Select ------------- Other: ------------- AT&T Aerospace Amazon.com, Inc. American Red Cross Anthem Ball Aerospace & Technologies Corp. Bank of America BankNorth, N.A. Bath Iron Works Boeing Running and Track Squad Booz Allen Hamilton CIGNA CORE, Inc. Chevron City of Portland, ME Cross Country Energy Enron Corp. Enron/Ruan ExxonMobil GE Runners General Atomics Hewlett-Packard Hughes IBM IDEXX Laboratories Kaiser Permanente Kenneth S. Nugent, P.C. L.L.Bean LG&E Power Inc. Lockheed Martin Lucent Technologies Microsoft National Semiconductor Network Systems Plus/Ruan Non-Scoring Northrop Grumman Denver Oracle Pacific Bell Runners Patton Boggs LLP Principal Financial Group Qwest Communications RADAR TS Raytheon RealNetworks Rigel Ruan SBC Communications SCVAL Semiconductor of Maine Sempra Energy Sensata Technologies, Inc. Shell Oil Company US State of Maine Sun Microsystems TRW Texas Capital Advisors Texas Instruments The Boeing Corporation Unattached (no team) United Space Alliance University of Southern Maine Unum Victrex Athletics WEX Wright Express Yahoo! self employed			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.