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.
Action* Create a new Membership for a new person, for year(s) starting in
Start or Renew my Membership, for 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  
  work           cell           home  
Email* (privacy notice below)
Team*
Type* employee,   retiree,   contractor,   alumni,   family member,   other
(see USCAA definitions of types)
Employer
  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 as a member:
Username (your email address above - MAKE SURE IT'S CORRECT!)
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.

Participants agree to hold harmless, indemnify, and defend the State of California, the Trustees of the California State University, the California State University San Marcos and the officers, employees, duly authorized volunteers, and agents of each of them (University) from and against any and all liability, loss, damage, expense, costs of every nature, and causes of actions, except for the sole negligence or willful misconduct of University, arising out of or in connection with our use of the property referenced above in the provision of services for this 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, PO Box 208 West Simsbury, CT 06092-0208

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