The Virgin Islands Track & Field Federation

Registration Form 2003 (Please print form to complete)

I am an Athlete___Coach___Official___Volunteer___Parent___Supporter___Team___Sponsor___Other___

Please check where appropriate.

To be eligible for a Virgin Islands Track & Field National Team, athletes, coaches, officials, volunteers are required to complete this form and meet applicable criteria. The annual registration fee is $10.00 for individuals and $25 for clubs/organizations.

Registration#:

Fee Paid: Yes: [ ] No: [ ] Amount:

Date:

Last Name:

First Name:

Middle Name:

Mailing

Address:

 

 

 

 

Telephone#

Home:

Work

Cell::

Fax:

E-Mail:

Residence Address:

 

 

Date of Birth:

Place of Birth:

Are you a citizen of the United States of America? Yes [ ] No [ ]
If you are a U.S. citizen, what is your passport #?                                                                        Expiration date:

If you live in the U.S. Virgin Islands, how long , and on which island?
 

If you are not a citizen of the United States, please answer the following questions on lines A. B.

A. Nationality/Citizenship of what country do you claim?
  1. Are you a Permanent Resident of the U.S.? Yes: [ ] No: [ ] Other Status? Please explain:

 

 

Athletes, Coaches and Officials representing the Virgin Islands must have a valid U.S. Passport

Passport #: [ ] Date of Issue: [ ] Date of Expiration: [ ] Birth Certificate#: [ ]

You are an/a Athlete [ ] Coach [ ] Official [ ] Parent [ ] Volunteer [ ] Other [ ] Check each that applies

You are affiliated with: a School [ ] Club [ ] Organization [ ] College/University [ ] Military [ ]

Please provide the name of the one/s which apply:

 

Your coaches name, Address, Phone #:

 

Please list the event/s in which you compete:

1. 2.
3. 4.
5. 6.

If you have competed or coached for a country other than the U.S. Virgin Islands, Please provide the name of the country, the sports, events and competitions competed:

Please continue on back of this page:

Competition and coaching activities other countries continued:

 

 

 

 

If you have competed or coached for a country other than the U.S. Virgin Islands, Please provide the name of the country, the sports, events and competitions competed:

Please continue on back of this page:

Competition and coaching activities other countries continued:

 

 

Do you have allergies? Yes [ ] No [ ] If yes explain

 

Do you have medical insurance? Yes [ ] No [ ] If yes indicate type of insurance, name of company:

 

What is your occupation?

Biography—What high school, college did/do you attend? What was your major? Degree/s, honors? If you are a in the military or a veteran, please indicate what branch, what period, career field, honors?

 

 

List previous major competitions and best results you have achieved:

 

 

 

I,______________________________, do solemnly swear or affirm that the above information is correct.

Your signature:_____________________________________Date:_________

Please provide passport size photograph for you Federation I.D. card.

Please return this form and payment to:

The Virgin Islands Track and Field Federation
408 Strand St., Frederiksted,
St.Croix, Virgin Islands 00840
340-772-0412
340-772-0212 fax
 

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