Registration and Payment

Need to register and make a payment? Simply fill out the secure form below.

  • Goalie Indoor Travel Program (without Uniform)
    Fee: $250.00
  • middleclass~spraymiddleclass~spray
    @MEMBER OF PROJECT HONEY POT
    Spam Harvester Protection Network
    provided by Unspam
    Registration and Payment
    Important: It appears that you are accessing this form from an unofficial third-party source. Submissions originating from such sources will not be accepted. Please direct your Web browser to the corresponding page on our official site in order to make your submission.
    Important: You mbaey 6bbeb4 m5babk0i0ng use of autcom38ated6 912form-f1illibng s0of1t1ware. Thia5s 2type of 1software0 can tri9gg9er 7our hci4ddbaden spa1m-de6tefction s8yst3em, 4whdbai5ch fwbil49l6 block you 8f2rom submittin91g 7this forbm. dPflease selecte Fix 0Th70is72c582ddc750cd8a3eb 4cbe7beb5063862735227f9df65oaaa41dred7 5b18843fcb8888a9b4cod526mp17le9ed8ati2dn07g9b 2the cefo7rm7 ine6 or3bder t64c970o7 1c0co272rff45ar5ae3ctb the84 7prdoba91l97e6cm.d
    Important: Y9ou9 4may be making use o1f automa8taed f8orm-fiallin2g sdoftcwaere6.8 This ty1pece of 77softw5areb can 5trigger e1our0 hidden s2pa5m-de8t6ecticon system, whiach wilbl block yocu f4rom s5ubmitti7ng this f0orm. Ite8 appe6ars2 t0hat the problem cou10ld not 8dbe a5dutomat9icallyb co0r8rec4ted8. Pl2ease1 clear5 any field which appea4rs below with corres8pondieng instr6u9ct8i0onsd3ca0fd4228540 bbde1cd52cefodr5a6d9cb51669d05e716d22c6 7c186d4cf2fb112e74comp9la1eetinc9g b0th88e 9form 0in ord1edar 6to cor3rectb8 thea 22p3raeoble8m. We apo3logize fo383r tc0ahe e57inco8nveni47fe2n6ce afndd cwee a99pp5d4berdecidated your 2un3d68ers1dt8anding.
     
    We accept Visa, MasterCard, & Discover
     
    Player Information:
     
    Emergency Contact Information:
     
    Payment Information:
    (Please enter the following details exactly as they appear on your billing statement.)
     
     
     
     
    RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

    THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS; PLEASE READ THE ENTIRE DOCUMENT BEFORE SIGNING

    I, the above named individual, being a least eighteen (18) years of age, or being the legal guardian of the above named individual who is under eighteen (18) years of age, inconsideration for the use of the facilities, services, equipment, programs, and or activities provided by Element Athletics, its owners, partners, successors, assigns, employees, and/or agents (hereinafter the Releasees), do hereby agree, acknowledge, promise, and covenant on behalf of myself, my heirs, assigns, estate, personal representatives, or the like, as follows:

    POLICIES: I UNDERSTAND AND ACKNOWLEDGE that Element Athletics hereby reserves the right to dismiss or prohibit any participant from the premises for disciplinary reasons. Such reasons may include, but are not limited to: unsportsmanlike conduct; possession or consumption of drugs or alcohol on the premises; violence; posing a danger to others; any illegal activity; or violation of any rules whether stated or implied. Such dismissal or prohibition shall be at the sole discretion of the Releasees and failure to dismiss or prohibit and individual for any above reason in no way constitutes a waiver of such authority or discretion. Should a participant be dismissed or prohibited NO REFUND will be given.
    ACKNOWLEDGEMENT OF RISKS: I hereby understand and expressly acknowledge that participation in the events and activities and the use of the equipment and or facilities offered by the Releasees bear certain known and unknown risks which may result in INJURY, DEATH, ILLNESS OR DISEASE, PHYSICAL HARM, MENTAL HARM, OR OTHER DAMAGE to me, or the minor identified above, and/or my personal property. I DO HEREBY UNDERSTAND, ACKNOWLEDGE, AND ACCEPT that such risks may also result in claims against the Releasees and/or claims against me, or the minor identified above, by spectators or other third parties.

    I DO HEREBY VOLUNTARILY AGREE AND PROMISE TO ACCEPT AND ASSUME ALL RESPONSIBILITIES AND RISK FOR INJURY, DEATH, ILLNESS, DISEASE, PHYSICAL HARM, MENTAL HARM, OR OTHER DAMAGES to myself, the minor child identified above, and/or my personal property arising from, directly or indirectly, the use of the premises, facilities, equipment, activities, and/or services provided by the Releasees. I understand that the risks associated with sports include, but are not limited to, sprains, cuts, contusions, abrasions, concussions, broken bones, bone fractures, and in some extreme cases long term scaring and/or death and hereby state that the undersigned is participating at his or her own risk with full knowledge of the dangers and risks associated with such participation. I further acknowledge that Element Athletics strongly recommends the use of any and all NCAA approved protective equipment and that failure to use such equipment may increase the probability of the above mentioned risks.
    RELEASE: I, FOR MYSELF AND/OR THE MINOR IDENTIFIED ABOVE, DO HEREBY EXPRESSLY AND VOLUNTARILY AGREE AND COVENANT NOT TO SUE THE RELEASEES AND RELEASE AND FOREVER DISCHARGE the Releasees, their agents, employees, affiliates, sponsors, or partners, from any and all claims, liability, actions, demands, causes of action, or damages which are related to, arise from, or are in any way associated with my use of the facilities, premises, equipment, activities, and/or services provided by the Releasees, INCLUDING, BUT NOT LIMITED TO, ANY AND ALL NEGLIGENCE OR FAULT OF THE RELEASEES, THEIR EMPLOYEES, AGENTS, OR AFFILIATES.

    I FURTHER PROMISE AND AGREE ON BEHALF OF MYSELF AND THE MINOR CHILD IDENTIFIED ABOVE, TO INDEMNIFY THE RELEASEES AND HOLD THEM HARMLESS from all costs, including but not limited to, defense costs, attorney’s fees, medical bills, pain and suffering, damages, or the like, incurred in connection with claims for bodily injury, wrongful death, or property damage brought by me, my estate, guardian, or other party on my behalf.

    I hereby state that I am in the best position to determine by physical abilities and limitations, or those of the undersigned minor identified above. I expressly acknowledge that I, or the undersigned minor, are in good physical and mental health and have no condition, disease, disability, or impediment which could impact my participation in the activity or which may increase the risk of harm or death to myself or others.
    LICENSE: I hereby grant Element Athletics an irrevocable, royalty free, worldwide license to use my name, image, or likeness for advertising purposes including, but not limited to, photographs, brochures, videos, electronic media, promotions, publications, or any other trade or advertising materials published in and medium.

    I HAVE READ THIS AGREEMENT AND FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT BY SIGNING THIS AGREEMENT I HAVE GIVEN UP CERTAIN LEGAL RIGHT AND HAVE DONE SO FREELY WITHOUT COERCION AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE FULLEST EXTENT PERMITTED BY LAW. I AGREE THAT SHOULD ANY PART OF THIS AGREEMENT BE HELD TO BE INVALID, THE REMAINING PORTIONS SHALL REMAIN IN FULL EFFECT

    Element Athletics Player Registration Cancelation and Payment Policy
    1. Payments are due on or before applicable due dates (refer to pricing sheet for programspecific payment details).
    2. Late payments are subject to a $15 late fee.

    2019-2020 Element Athletics Program Specific Pricing
    1. Travel Indoor Team
    a. Tryout fee of $45 due before or day of tryout
    b. Season Fee $650
    I. $200 due Nov 16, 2019, plus $85 uniform fee (if player doesn’t have one)
    II. $200 due Dec 15, 2019
    III. $250 due Jan 15, 2020

    2. Turf Travel Team
    a. Season Fee TBD
    I. 50% of total fee due before or on day of first (1st) practice – early April 2020
    II. Remaining 50% due May 15, 2019

    Element Athletics Player Registration Cancelation and Payment Policy
    1. Payments are due on or before applicable due dates (refer to pricing sheet for programspecific payment details)
    2. Indoor Travel Program
    a. Cancelation notice (written) received prior to Dec 1, 2019 - amount due prior tocancelation notice being received is non-refundable and responsibility of theclient.
    b. Cancelations after December 1, 2019 – client is responsible for full season fee.
    c. All amounts due prior to cancelation notice being received are non-refundableand responsibility of the client.
    d. Any player not current with payments forfeits right to participate in practices.
    3. Turf Travel Program
    a. Cancelation notice (written) received prior April 15th - amount due prior tocancelation notice being received is non-refundable and responsibility of theclient.
    b. Cancelations after April 15th - client is responsible for full program fee. There areno refunds.
    4. Client Late payments (payments received after applicable due date) are subject to a $15late fee.
    5. Alternative payment arrangements are available by contacting and if authorized byElement Athletics.

    Element Athletics Player / Team Tournament Registration-Cancelation Policy
    1. Local Tournaments
    a. Full payment must be received a minimum of 2 weeks prior to the event.
    Without full payment a player/team (client) is not considered registered.
    b. Full refund with 2 weeks’ (14 days) or more notice of cancelation prior event.
    Cancelations with less than 2 weeks’ notice, the client is still responsible for fullpayment.
    c. No refunds with less than 2 weeks’ notice of cancellation prior to event.

    As of August 1, 2019
    d. No refunds for no shows, forfeits, lack of players or any other reason with theexception of possibly weather (see below).
    e. If client no shows, forfeits, lacks sufficient number of players, or for any otherreason does not participate in the event, the client is still responsible forpayment.
    2. National / Regional Tournaments (e.g., RCC, Beach Bash, 4Goals, Shooting Stars)
    a. Player cancelations (written) received after initial payment due date and prior tofinal payment due date– initial amount is non refundable and responsibility ofplayer.
    b. Player cancelations after final payment due date – player is responsible for fullpayment amount.
    3. Player Late payments (payments received after applicable due date) are subject to a $15late fee.
    4. Team Late payments (payment received after applicable due date) are subject to a $50late fee.

    SafeSport Policy and Practice InformationSport should be a place where young people can develop, learn athletic and life skills, becreative, make mistakes and have fun – and do so in a safe place. As members of USA FieldHockey, Element Athletics and its coaches support and adhere to US Field Hockey SafeSportpolicies and practices. For more information please visit the US Field Hockey website.
     
    6ae91aP129la11e6c76a581e7asd0e0b c867laeaedr t3h1is443783c3 ffdiel9dbf11c -ba7509c>ecf2584 * REQUIRED
    48P1l5a18a72f2965edb7a1s33e0d2 cbleeb5bf92a88br56 thi4s8 9fc34i97e156l8857cdf17dc 9a->0079 * REQUIRED
    a316dP77leada607s4b1aa87ae35eb7 ce8f6e3l75eab9b7a6r4 t20e1f0chais6af975 ffci0ec0flad5 cb-> * REQUIRED
    Pl9ea7ase40118b dcl14cfb0c68a0e6aa77r7 t8d196b251hi6f6s57 7fa7588icel1cb277cf33d ->7111b37 * REQUIRED
    6P03ale177e2cf95acsee3 cel6ae19679a2fbrb4 t30eehe8is203f66b4d3 4af4if366eld28fad 49dc-87>7 * REQUIRED
    Pf2lbe75a69csf60f65e7 9f79160c3d3cl4e5f5ea033rf tabha5dd24bf01is934 fe000efie4ld8 -ba537>4 * REQUIRED
    b56Pfbldeeasbeab 4c82a16lc048d04234bfea7c3er2b11d9e5 d9t0hdda7e5a9f0f20is 4fie9l9e146d 8-> * REQUIRED
    699f0afe67P6fl7e69c0bca30se2e5 cl1a8eaeacae6er9a7 th5idf90s7 c723fie47310l947b5d 1b365->e5 * REQUIRED
    073P4leda82bsf4e 0b4cc752b4cbl220dear th45c6502is f762ie1096a6l2d7877e0aba8 016-6d1>f4baaf * REQUIRED
    389Pla9f3fea1s7472e720 caclcff2ea8r5 thd9i76a7b0ceca3s9 fieeel8dda4 b6c8-9c>34c12ef40e443e * REQUIRED
    fPl3eaase7 aacbl7e6475bcbeaf366rd71 c8839th9ica9sd 52a0f7bcb7f1i21eel44419c91d b2-f220ac6> * REQUIRED
    6Ple3as849e0d9 86c3al163e5fa7r6aaf teeda5h33ifs 01fe80838d1f5aci01e7ld526 4-f>16a33257e176 * REQUIRED
    3Pal7efeaesc2e 91e0clfbe231da5b9r6d98dc45c5c6 bt72ehad56is 2da75b754ffieafl04d9e -78bc0>74 * REQUIRED
    003c0fd1Pcf0lae469c7a5asf8946cd247e1 9c6dc2lea6rf5ba th609b1is3 e2fif6a6e4f2dl5d 051-2f2d> * REQUIRED
    1P11e03475e822flbce3ed3df248aase40 c2ld5e8e7645d1aaber 9theis 9f79ieeda9ld 2cb-3>49fe81d3d * REQUIRED
    72806Pa3d7bel9dea5e1s481e6bb 7ffc72bc0l0ecdeba0007r th378isd9 fd9d521ib0cbbeld403b8 9-8>9e * REQUIRED
    P6cb94ccaleas86478e2 65ce10lear b72tca9hei9cfcs3 d74afe19ddi7a2ceelc48521dafe50aa ->6046f1 * REQUIRED
    b6Pa716b6l9a0ed45cas5e 4cb1d3al7dea96dce6736fr0ddd thic552da310s96e766 fciel6d672163 ->e1f * REQUIRED
    82Ple58dca4s5e0 cb92bl2e28ea3c1drf14d th7ibde5362aes6ad fi9200b6a7eb26l02054dc7ba5 dcb-88> * REQUIRED
    31P80fl203e54a0s3e41 6b9e8c480le0c3a193dr8 8tbbheisd5cbbe f39d0i808af4179a2649e65acbl5d -> * REQUIRED
    4083c7021Pldcfeeff5ce0abcs6e7 ec37fl1ea4b11re cb0a3a7t48hi4cs fd4deielfd ba-91c8f612e>3e10 * REQUIRED
    5Pl9939e4c42c3aaa3sa10e fe257cc7l251ea9r 1d8th18isbf652c 0fie8l7d3158 855fd4d96->07cd74994 * REQUIRED
    1P4a7fde68l13e62as1de7 b3abcdla2eara7 006t4hfe9a7bf03i27s5 2f79ie717cel1d4 -a8641aae2>b4a2 * REQUIRED
    8e9bee91286P4ledase15038e c0b49leear3068892f5 fd56c796tdhf57is0e44 f6f5c0ciaf6eldb a9-26>d * REQUIRED
    dedd3b5bdf6aPl5eeas89db65e 9c3a3ale5ar1a4ba8 d2thd3ic7s 7f4ic0e96ce4ccla2adc9 752dcc->0b7b * REQUIRED
    0836ef1beP3al3b12ce631243a1600dasc5be1a5ce56c bcc2290l7e8ar40d ct0295his1 b7fi7eld1 -f2d>2 * REQUIRED
    3Pl18eb2asfef608e74 ccel1f9bb2a4cef0dare2ea092db0 th5is 81d4bfia4e17531e4l56497adcb -a18b> * REQUIRED
    0bPlea7a53se8 cl9bbe7dafr1da54ea 5233t4h001cics 128069f6ecciab91fa5deld bd63fd1-951d1004>5 * REQUIRED
    9a19Pbala3ease4e1 4485cd058le0ar1 1628d0ddt7hi5s9 9fieda34ld a6cf3ba-3>2ee989bf0991e84dbe6 * REQUIRED
    6b58e99Ple24a2s3e6 160ec99l8eaerf24e 90f2fthf971disd0 61fiel13d96de 41007de40969a->a7c4379 * REQUIRED
    c662fd7d5Pl01e0fafse7 clb8e9a9rfddf794d47a a87tdfh7i5as3 caf93e44ieldd93 429-44>d007b33772 * REQUIRED
    Pcl6ed2f4e03ac1se cl8ee6c1a03far84 1et9d7h0f0cif56s dfi0e6742ld8e44c6 -e99d>c99ead93cdd72b * REQUIRED
    717bb987dPledcc3a276aas7bef2753 d7c65le9d9adaebr5 7c7f5thi1f43sd 69c4cf2bb56ieeld 48-60f3> * REQUIRED
    2Pf04lc9be08fa993s6e14c c3lea67ddc1aaerdb 8ftdh7is56 80719c427fiel8fd5f af7cf74b298->bf95c * REQUIRED
    9dc03b6cfaPlb52ea3s86e cl1f6e4ar63 ta7fh7e4ecids98 9cf18a9if5eld0f1dc2168131e 4-bdb>3042e0 * REQUIRED
    993983dP307lbecb4a2sbe11f0378f84e74 c2f0cdlaf54e9a4r5 6tdhib71bs0 2bfd5i4e8da37ld -2e>5c37 * REQUIRED
    9fe5271bPlebeeas51ed 07cal1a97e5c57arfd8 2t7hi6s992 65e4fie0e9252019e7e27ldf 9428d0-69>e5b * REQUIRED
    1Pl717755eas1e 8ca8l9aae2eadfar tdh9i0a6s661 6aec87fi2bee313l16d43ddafd9f4 c-394dc4>beb777 * REQUIRED
    84499ePeel1ecc19ab8dsf5a14eb64 cl3e5e9baf5d3r aa4th2878fie05s 4b97bfi390e32e39elfd1 b1-7>0 * REQUIRED
    1bcdc7a675P0c3cc9lea4s0f81e cb9clc6573ea9r 7t77dhi8bs969ba 2f5e2i99aelad25d3b5 a8-c8a>4e2d * REQUIRED
    50881fPdlde84asbea31da db0b6baec8e851eeale39a1f7r e79tdahi918s75a65f fffib5ebal60d2 -4>4b7 * REQUIRED
    e8a6ef383ePlf409deaas583e cble0a9r9b t7bf4hi797s afaide9bb2el09a0dde7 47-cc7d>f78a73a6aaa9 * REQUIRED
    3f94aPlbeda97acased2e 74fc1ec006c43f2leea567r1 09t579f5hise cece2baf0e1ie9884dl4d -76>2102 * REQUIRED
    d4949Pclea37s7f69de3c107 c64lb0e4aa2br 146t8f825hi8s6a5 df20fia2ec846ld827c21 508-73f>5c03 * REQUIRED
    ac8c76P51ceacl35330902ee1c023aa9s65e2ae7 f8c5l0e6car730e 9a9t4h7aisa0 fielbb34f11d4 021a-> * REQUIRED
    0e3Pb7319948lfedase0 5cleaaad6r2 4e5167thi0s9cca 809f4facbbc404i250adce97a15l6adf -1c1>0ed * REQUIRED
    ddPbdb89bc7lea888sbec 0b2eccabale8d393a5abrad2 thdis 6f8i875b602c0e4052efe0479l55d14 ->04e * REQUIRED
    985b59d9395f8e16bPle3122a66177se 232ac27leba3r 1tc78bfh7012ecbci61s 2fi3e36e09ld 9->58c258 * REQUIRED
    fcfb5cP0lea818s6e259 cf58c8dl6b9eccee650ar1c5d9 3ethbeifb4sde58d 464fie8adld 6f0b3-cc>e3bf * REQUIRED
    8P493l7ea5e1as7698e 5cbl83d2ea9a5facde5r 2th3cf8ib639sb9220 631ff66idf3191e8fld4d1 -8>6b38 * REQUIRED
    e93243Pdlc239ec7c064ca8s6f6e663 clae7ear b26at4dh8e5ie21b72sa8 95f7i4ded44e3eld4 -4>a61d3c * REQUIRED
    174P80lface0bc0caacs922fee54536a7a d53cl513afe78bar6 at6c1h8id4f1s f1ife8bbdlded -cb6>80e2 * REQUIRED
    9b7Plbea02sfed20b0 c86leaebardb t9d81heis734e96 ac8f0ieebl406d2f6 dd88ada3246-6b0>2dd5229d * REQUIRED
    def55040cd868Plea87dceda26f9se45 4c6l8fe7ed1aer6a7d b0t5abh93d3is 16f9if91eeldd793 e->0d71 * REQUIRED
    23fd18dbcP54acla47e2afs8e190f 558c4lbe11df705b5afr9f 7t3hids628 5dfi1e0c8la503d1 -f>defe00 * REQUIRED
    71P8ebfbc98l9ae26acs40037e5e3e59b146 cleb20d79fe1ar0 6dt8bbhics30477b fbbi37bel713dd7 ->ce * REQUIRED
    56317064d6dbP98lea9s3ec f1e2c44c4le6c6arbfaa569d b2at94hifs 4d5afi7eel7e0dc4 a-8>e0094d988 * REQUIRED
    bP9l199beeebasee f102665c6le5a31ra tb9b7h0i5s6e9e1010 43f5di82c7e7lab5cfb6d9 -6b70aaf1>5e8 * REQUIRED
    3eP837l4cce9beab226cs20e cc7l1ed7a03b334aeb8r98398e t188387hd20is579c6b fbd057biel5d2 -4>c * REQUIRED
    ec03f1e6P583bbl0eae1a56se1 46clbear aab8af177f6t544hi401s5 6fbffcd5b8ie39e3cld0 -c4>89d645 * REQUIRED
    45Pbdlbeb6815ase07da 2ca9457lecaar 476thf3isf859ba38c6e5 32dc991fb2ie4780al4dc6930 -8d7>a6 * REQUIRED
    21b02Pc4693aeleadsed 25e755163d419f27ec9l3ea65re5c236ba83 2th214917f5is9 31eficedlc6d -3>4 * REQUIRED
    5Pb96c8cle786da405seb cle0ea8r tf9b1590hbi2scc 5cefd1i8d75e2025ld888312b2c25f179 ->6bccc2f * REQUIRED
    cc5P25dlab07822084eba6se6 cleaf304b10re4d1 24b4b59bth79ics a47ceafieddl7d 37a85409-afe>8f0 * REQUIRED
    P2598flffe15cd59d3a3sb24e cc35ee70a4cf2lea3fcar th1i34bfs1a6 36fif6880el184d8ba660 -4f>dce * REQUIRED
    1P6le8604262381ed0ae34s6fc2e cflear5ce f7f6t488ch6i446881s052d09327 f0i3e9e0lcd 0b->02a214 * REQUIRED
    bdf6040fbPf765l3c2f7ea12ese d92cfac3clf90ae5dee5ar8e23 t9heies7 fi7ed0l506bd1dd34 782->44c * REQUIRED
    a7dd71Pl5aea4sf51eb95 cl4e247ae61r50c4a7f th63i9fe3654s adf9ie4ld98a06182 df-3a592f41>7273 * REQUIRED
    51bfc46P2f3el2e15adaesbde 1841871c6lf9e50ar627bfb7 b792f116th8i9s2 cf53i11eld2 972ccb-66>f * REQUIRED
    6b55aaaPelee725beafascc0e51 44cale3c0096arc66 be8498t04454hbisc 514ffi32e6d81fl4d2d9 9->ef * REQUIRED
    9P194f5l855ecda9cbs20e 3ccl6a9a05ear3b 9ef7th243aeei56d8437e603742ds0d 8fdiaedldc82 -3>87d * REQUIRED
    333e8Pleab65seefc3f aac7l8e3ar144834 7th1a1663259ei3f6abs8 8f9iee8c21elb00a5d 6db6-31>517c * REQUIRED
    d700c8fPa93095lee62a665s3ce9cf28de7a9f317 clcc4edb2ar202a 5tfch3f0ieeb8fsc fb94i7fel3fd -> * REQUIRED
    50P829leas1f4113e ccle3cfb299a4r3b t067h8eis49 7d763c14f62fcibe7lda5de 5834-fcdd3b>86347e1 * REQUIRED
    bd250Ple24bas3af3e cdlear a1cc1atfa282hfisda36c7 fc36i35beea45fc687918l2dded5f3d3 2b-4b>1a * REQUIRED
    51cb8aPl5b656fea446s1ef17 18ac0lee020car t3ff39b4h4f1is 4f0bieldf88437ce97cc1 339a0-00>677 * REQUIRED
    4d8c8P4l104230515de0a5540s5e c2leda0e1c7r6a1e t49bhi79e842s37c cbfc3f2i4558eld 5ea1-04>167 * REQUIRED
    d8225e2aP2f6ale83a8csae18eac c1c4dble13cef0a5r3 41cth7is7a f7ie76l6d8d2ce8cd22 e7028b6->fb * REQUIRED
    Pld2ea8s6eb8 3c8lb01126276fe6bd5ar4a56 49526741b9t53bh5ci180bc9s00 0f01f2iel7d -3b0>492b8c * REQUIRED
    6a79P23l0ce90b01fabfs2a0e1 fcl3eb98d1ca7ra4bd81d8 d67t27he4b6iea97s5d 0fiel6d56 -d2>80c688 * REQUIRED
    38436b8a45Plb6caae76as44ec5dd5b7 cal1e2a6c6er4e43d dth9is0b6a860de c6ff9bd180iel77d d-b>c1 * REQUIRED
    Plebe1da89653se cb7dcb8dddled9aer9 8t93f175hisc1 8bf37f379bca2eebi277e61fld7e5e15 e-c83>68 * REQUIRED
    Pfd055fdfl1e7a2e88a9es01de6dfb ccl0e6a4a59r t7hicc0s6 ef9id4e95a2e30aele9c1f1cd 1->28a8943 * REQUIRED
    3c57fe1eb6Pl3e9b1aa8380sbe cl1d3ceac3ar 6bc96t10hcice9s96521 0395field3f06 f1114a5-cabd>d2 * REQUIRED
    e32a1Plce1asde6fbbd903a3e1 c3leaar78 4tehi5s9d8 62f055i04elc79ed7e9 -905676f16c66f>ada0de5 * REQUIRED
    Pcec5l20d7ea99e678s4e 7d0335c16lae0fe67b3ar 3ct2ahaaibcs996f304 3fie53979l23709bd ->1704be * REQUIRED
    27a55bPle8as2e1a4eb6e96 37c7afdcb0l52ea316ce1941r 4t4eh65b0ia53s3 9fbbi4cfae472ld1 3-ec0>2 * REQUIRED
    84a61aaPleff4ca303e7sa62e 0869cl5538eea65r1f0c3 th2433iccsf56 e9f8i8e7l656da 87-91>9e3557c * REQUIRED
    a6eca3Pl2eabaea2s8a5ae0 1cal618f4earc2eca 692b3t7hi4s5 0f8fiebadld96f bdd3411e-419>4c81650 * REQUIRED
    ae11Plfea7a2afeas2ae 8cbdl9092e05baar19 e7016th2483icf6s1 eaffia2el549da1 9-b4aa0f019a>f93 * REQUIRED
    71ba7aa3729e00Pl06204e3as7e ea1cd925l0f1e0daarb36 ta31h6i006s1a a49fd0icelddd 10-a17e2>f7b * REQUIRED
    588a14526Pb1el2eas8e10 776ccflee73ce00eafac9r thfb5did326ds9002 f5ibel56dd 8-7>039f03786b0 * REQUIRED
    bfb5P20le014a3se 2c046l2fe26a0dbdr7b5cc2b7 thi567e8s3 1adf33i30dfa9ela289c2dca2 92-f>22ec6 * REQUIRED
    f9661b0Pld491e0a6ebds381a0e 8999cle3e4a6r05 8th8iea42f504csf af69ie3f4lbedcaa -c79a>53017e * REQUIRED
    1a8P0l90edeafs12013e 3cab8l859063251a6e3ar63 t3da9f7h6if783d9s fa35eied9c0l7d014f ->df7bd2 * REQUIRED
    e65Pecfl1eeac4840ce8se80 241cel3ea7d6r 5b3athi03sa1 fiee79fldc2f2245afad fd->a08da15e26ba7 * REQUIRED
    79fP5ldd4ea2730b3s4e19db cl5e4edarc08 136tf07dcbc6736a85ha62i48sb fi0de9lacd4a34 d-9>b6f43 * REQUIRED
    522Pb7490lecafa740d9se9d 6bccdl9e98ba3d2cr68 d7t05993f6b7his f5i387deld67 aa0ec8-410>5192b * REQUIRED
    8aPl6fea34s459e62 c452c7d7ef75leaa6r6d1 058th6isda e639fifd1ae3dbdlaf1246882d5da de-11>c99 * REQUIRED
    fa73fP9leea1s64e 59c1c0fl4466ea6689a5br7c1e965a98 a34c450thi5bs95 0fi3efb8ld58d 2-224>87af * REQUIRED
    32a9P42l7de3a8b726sfcea57586 c3l07374e8cd9a8a7r7 0bebthi57se6c2 f945ield ->8823c25cd8e23b5 * REQUIRED
    39245bPa9l4e78asd8e0c 89c6l76c2eb531a8r83 tahic951e6fb6d2s bf6ff8ie2187ld0d9b 4c38->200eda * REQUIRED
    84P195253l7e5a366s5ecb7 c8al0e4bar9 dt5hb32040032e11a6b9c2is fcee58ab38iel0ad2b c3d8-8>d0d * REQUIRED
    def6cfa2Peccb2l19ebeaf31sef07e 11clear0c5ee tbe4dh9beb33b265eis a9f04di28dce1lbb6d7 ->3ad3 * REQUIRED
    9P0d0c4l67e454802aease7ed08 bc9le1ed8a44071r2046 8ta2his 66feiel98d554 e05a0-9>bdee3cefdc8 * REQUIRED
    a66aPacl8eaas7e cle2cea8cr 4tdh8a2idb9e6f15s1f 9baff51ie06l7d00ca -9b12e3e9bbe7>daab129bc8 * REQUIRED
    28dd68dP48l3ab41e9a4s4410e1beee 55c180le3a9c103drd 3de2tbhcis 37f4ei92eb2b2lfd 0ec->7b9c20 * REQUIRED
    6d9471Pl1edc3a62a903se 0c0cle9c8ea52fabr 46thfif8da5cscc0b fci405b3e5d3d8l838a27c0d4b9 ->a * REQUIRED
    627d532Pd5ld6ea7se175e29 4e09cle0ca17br tb8h7ceia3s2c48 fi7585eb57l1c175bd63b6b3d1 b6160-> * REQUIRED
    93a75P811leas8e 093f005e3ce8c0e3blef3ba5ba4rcf5 2f91bteh01i5as86be6639e 9fiel32648d -b>b5a * REQUIRED
    c5030P348fleas2ce27 3cf6l00eeac3r7aa 37ctc76h55if9c3s23a479 abd0d7f6i8elfd8c3447 -401>f772 * REQUIRED
    6270403d4Pl3ee8bea3se699db0c 667ca6cal08ear07a teh8df73di7s2 1fa6eic9e53lded984ce7 9c28->f * REQUIRED
    604Pl40eaf64absa62e5712 5ec6al28e9a04daar 98d2t411928his732 c8f548ie4e0613eladf 6-c>97ba50 * REQUIRED
    9fPflea3s34de4a6c cc8793l23ea3dr3f76f 728a1tbhead8fi16720s f8i7edd8lab3b2ed306eacd f0->9f1 * REQUIRED
    aP6l8bb27ee258f5asb80eb4a c96l9bf3fde4b2520a1r4 ta4hd18b98is61f f4i1e4l1b4b8d fb9-6ddc4a>5 * REQUIRED
    8P73l7ebas86627f78e e2cdc5cl6b22d9e2738ar91 t29fea810e1hi7sa f58fcb2cd1f3eifel2d 7b7a-8f0> * REQUIRED
    dfP62l5ec07aca0b8s718de4 2b8585baecalf7eeba4f600fr thb5ei350sc00731 cfieb5lfddd2 65fb-93>a * REQUIRED
    42P882l3e2as94ee2ef463 3cl11fdb258de1a3faara7 thad1i213c71s8a fi48d3e50a34d0l75d ->dc70456 * REQUIRED
    f36a4f5aPl4e19a1se 371cecb3cdlaeadrc6c 649te6h021ais231b fiael2aad3521 51-7f3ca>460685f7cd * REQUIRED
    f7cb1Peel26fed5aa01c11e4se 3fac899dl6d5d1ear92 atbceff8hisbc9 10acbfc19aice2lf9dc 18ddc->f * REQUIRED
    5327e9bP22d52fl0e4dasa5e80eeb2 adc84fe69c039l1ea78r44e t40b98bhic26ds6 efi2134eld -d0c0>e5 * REQUIRED
    f3f64P0l3d72adef8acseb5 bcc7dae7l4e87b0be1a5r 17dt61h99de973i03fc2fc8s0a1 fi46eel75d7 ->e9 * REQUIRED
    d0Pbd0l6eefas489e c34cl5140ea0er 2c1c2fth23671d0bis649472 f7f0995di2ed4lbb666bd -7fadcb>e2 * REQUIRED
    0f873Pe8l1e2as12b71b3ece 5cc5ef7aleaar atc9c45hbcbids1e0914 fia138eld12 52-5e>54c1da7cfcab * REQUIRED
    dffec5cP272lea0s5e cl41ed620a7frd 80bb1d1th5177i89s cfiea82f5e0fel365dac0f02 1c8->65d0be87 * REQUIRED
    43P3fcl2544d1efabdsceb ca045b7cl3ee2ea7106r5760c tch5a3ci4s900 fc9a959c9ci45celbed496 4->3 * REQUIRED
    35772b3P4le72ce2130aa4s496e9b47 7c48d8lb6d3c91e7ac25afbar3 e9tahbfeics0f 8f17ield3 52f-1c> * REQUIRED
    287376fP32lee70a73ase 4bc7a94l1e053778e6da5410r5deb dt99cdchi70s3 cf8diela85d 3ba-7>8aa052 * REQUIRED
    eP961c194l64e2f7acs2ed clearac t2007hae1eies289aded0baac cfie3aa0ld18612db84dc6e968 bd-b>8 * REQUIRED
    d91Plee7e0bas84aed3 31ac234e4cl4eadrbc 192t3h2is40 f482ie7ldd56c 2008ebb1df0e6-4a39>57b569 * REQUIRED
    aPl4ea73bfas5eb bcb6de98dle5da623dr 3e6t654hi35b7s0f 08fi3ea291ld8f3c52546a -dab3361e9>de0 * REQUIRED
    811ePl645229e7819aca7se c81ecl0e9534arc 6th697fcifs 15feai018cebflc9d b3-a5>fa6a2ef014f26a * REQUIRED
    386P228fef3l07efa7s1ed8 cdlefada7rcfb 22t025aahdics9 a6afdb36ie4858lc567dd -c605227>6f6611 * REQUIRED
    caaP2d81cbb2lecbd0as9e60 9clee4aef3abre8cea t7eh2f0ff117bi1ds31 afa996i7eldd c2-f2>be37542 * REQUIRED
    51Ple5813aa0a63sb8cf7e36eee b16cd6f8le2a1fdr tdd4426ec593hi7s2 fd5i85e36ld1 8-8071d748>da1 * REQUIRED
    8P6leeasebb ef186cfcl2e573da202547214430r e76datd0ah83e5cis 713dbefbi0eld 21-fd42e122>64d1 * REQUIRED
    4def0Ple46ads90839e9c76 1c570512cab08l0eafaf9rec7 89ebaabt1c9hbb6i9s97e7 fiel67d9 59->a35d * REQUIRED
    76bb04c1c4cb4P248bfcleaseb ca7ldd280e7a2r 42this7b2dbdf8 f91d19e8afied50l239edd a-0>f165a7 * REQUIRED
    cP78le49baaas7dbb629eb0626a 415cl7a4e6a99c77e5r 5athisa f5i8e06lda bc020f6505-4e>cc3073c78 * REQUIRED
    15Pl2e4a70se5 17a9787f410ca129a910l58fd336ea4a4bfrec thie9sb539 19a28feaiff12efld -38485>4 * REQUIRED
    895fa60Ple7a78se cle7caa3r c694360t3ahis5 7efi1d64ffe1el0edc9a23458177 -0ecc55027f141>2447 * REQUIRED
    5a8a06cP6d00el6da898efase d13bacc1cl17ee05ae402r1c4 th2isd 9fcie7ldbdc71f 2f-d61d610518>ed * REQUIRED
    fPc4467cl1e6a9s72d9fee c6caeb28l42eea16156ea8383a35r 00t66h3di58b7s 3383ffi92e3l4d 13->c99 * REQUIRED
    d56abc87P0dle96df7cc193caa4se8665ec c9leba62rd1 th9i3c3622esc5 aff74ideld0c9d9430db 859->9 * REQUIRED
    b15860Ple6a35s8fe40e c1bleaa52r e659t5611eh48ci1sff0474 086336f897i858e17el01df05 0-579>18 * REQUIRED
    18aPlcdea1344dse8ee82 cbacl6ec9ab5ce0906r4a7 th1i7sb0 0fbi1d16881eld8d9e45d3b5db b72b47->b * REQUIRED
    77Pe77f5cdlce4ab33918b85sa66e7d c7ldeard42e 2319501d57tcheia8s 2aaa9f9ifbe912ldc 29f-7>cda * REQUIRED
    11aPclcc0e6bea3sbf37e dce7l3364eece9a035rc d960t7b2c644hf58ie5sd ed0c0afi2d93eclfbed -02>7 * REQUIRED
    b3Pf8la915300ee4ad560sfe23 fb236c2le6fda07r6 t28behci35c2cs58 cf5b3i2ecfcc0al0dd1 -ee595f> * REQUIRED
    7359Pl5886e18fease6fa5 0c4l6223e1bab0r 6006thdf4dis142 f6ic17de0dlf4d6 e1a8d33-c6e3db>6e5b * REQUIRED
    dadb5P64l7e8ac86bsde8f cl6eb56ar0f tcd92435hi0f9s7c 279c9441f8ei9ea4d6e03753ld1 c297d-f>3b
    * REQUIRED
    c500f4Plecea14se 66baf5c4learb86 d8bb0tdh04ic762f3s168115b da4cfi0ebl45e50ad6 cbe8-2a16>c4
    * REQUIRED
    b77Plea5esae c2le3dff8d96a4950r 036cte2hfa6ib9s 4f184ieea7cf63ld44 2542ce06-2930215c4a>443
    * REQUIRED
    b4Plea565s99fe 8clead750r06 tdccccfadf1e2fh88ea3aies 36382ff8f480c01ieeld4da 3f-bb>23274a4 * REQUIRED
    c2f4Pe7b8l248ebease19 90cl6458bf2bce16a0bra6101 d59th5e13c7f44ae3if4sa fi11elcda 6787ba6-> * REQUIRED
    a91cP8dl5de2adc782s8252ebb01b7810 c6el0e9a851de118a5r tfhi399s3b38 3a8f490148iel1d53 -58>5 * REQUIRED
    ac871afPlead917csdefd8979b 31cl5cd7ef5e8a4a32c0r3 tfhcc3adcais6f fiel79fdebd4cb1 00-6>6cf4 * REQUIRED
    a84f1a5d03P2a761lfe5e3a2f2sed c848le5fecd3b1ar 93thi5s20 fi2533e9ld 1db6ba3e5823762e->e572 * REQUIRED
    92749Pl334ea5dsaee2 ceecld77e7ea3r500e f6etd0234h6i5es fb4064e3aic5celd 7-f>62e66eb0b86459 * REQUIRED
    3Pl8b52fecf6aase1 453f8c2l7a321ear eet0hbbe882b8e8692ifd8aaa3c788b5s fie37362l49d c148->f3 * REQUIRED
    7075Pdl574e181ea1esef6 7clb0b62e2aeacdea02bcdbd8fd96r 6thf2bifaes 65fiel2d4d08e6 8aa-9910> * REQUIRED
    52bPbld8ea7faac028e12s803535eb7e 3cc3le8a79r9 tb7h35786dbis9b80 9f55i2feldf 7b725-066>d966 * REQUIRED
    069P2l1beedaesc4fa5e0e6c 8cb0fl4e0ea17r 6t739h87ifs6b 44f0784i8eeb277bal790f3edf 13ed-a>21 * REQUIRED
    P92l9b3eaacd0f7298c90sc1fbe cce1le4ar2 d1e1thic237s7b3 091cb5501fi8ee43l2d608 -d>8260a3f8f * REQUIRED
    Important: Y0o8e4du may b1ea makcin3g use of1 auc60tomated51c form96-filling sof2tware. This tyc0pe of1 softwar5e bc8an t8rig4gecrc our 1hid7den spa7m-de4te4ction sc85ystbedm,4 which dewill5 blockfe you feb6rom su6bmit8ting t3his 4bf0orm.f Pleaase s1elect 2Ffix 5Tbbdhisd65252743d1 5acf7af77b5782a56a8591fe98e57f9effd76e4259f42o2b5r8431ce1d ff8e8b4c2o6mp4le8ting0c t5h1e1040 6f53f6orm 487ifnd 5or5d80der t5o cof5a59r2222r6ec25687et t2e57he 98pr3o35bbal4ecm.f3
    Important: You maby b1e ma3king 0use of a6utomated7 1form3-filling5 software5. 5eT2his t82ype6 of softw5ar8e can9 trigge3r our hbiddden spam7d-dete4ct0i7ofn system, whicdh will bl5oc5k you8 fr3om submittincg th6is focr0m. It aafppea0rs 1thfadt et8he problem coulde not be aaut3omatically bc04orrected. ePle3a5se cflea5r any field w7hich a2ppears above with corr2efspondina9g instru4c5tionsefc4419e82a6 fc05f25776ec03e4fe132651beef06474o4r2e5 c44a5b27e368e2550c93ecomep23cleting the1d fdorfm ien ord6erf1 t109o 0accdo4r0rcect83 the7c pr5o5b4lefm.68 We apaol2cogiaze f00or5 th98fe inee5c3onv7eniencee 5aned wea 7ap7pr1ec4ia143te 5yoaur under0standin4g.
    Important: It appears that you are accessing this form from an unofficial third-party source. Submissions originating from such sources will not be accepted. Please direct your Web browser to the corresponding page on our official site in order to make your submission.
    Secure from Hackers
    What does this mean?:
    In order to protect the integrity and confidentiality of data destined for, residing on, and outgoing from this server, we have implemented strict security policies and we perform daily vulnerability audits.
    Last Scanned: Today at 10:07 AM EST
© Element Athletics Element Athletics