Name: _______________________________________

Address: _____________________________________
City:__________________ State: ____ Zip: ________
Phone: ____________ Cell: ____________
Email: _______________________

Age: ____ D.O.B. __/__/__

Recent best times or races:
____________________________
____________________________
____________________________
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Pacific Association Membership:
If you plan on racing for the club in PAUSATF Championships or track meets you will need to register for a PA/USATF number. Purchase a membership at the USATF Website.

Annual membership dues are $20 and cover the calendar year. Please send completed application along with a check for $20 (payable to Strawberry Canyon TC) to:

Strawberry Canyon Track Club
2564 Walnut Blvd. #106
Walnut Creek, CA 94596