TEAM POWDERHORN ATHLETE PRE-REGISTRATION: USSA & U.S. PARALYMPICS

ABOUT PARTICIPANT

1. Which discipline:
   Ski Racing    Snowboard Racing
2. Current Recreational Skill Level:
   Beginner
   Intermediate
   Advanced
   Don't Know
   
3. Previous racing experience:
4. First Name:
5. Last Name:
6. Street Address:
7. City:
8. State:
   Choose from list Choose from list AA AE AP Guam Puerto Rico - - - - - - - - - - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other/Not Applicable     ZIP:
9. Home Phone Number:
   Format: xxx-xxx-xxxx
10. Work Phone Number:
    Format: xxx-xxx-xxxx
11. Cell Phone Number:
    Format: xxx-xxx-xxxx
12. E-mail address:
    Example: john2345@aol.com
13. Date of Birth:
    (mm/dd/yyyy)
14. Gender:
    male    female
15. Height:
    inches    centimeters
16. Weight:
    l bs    kilograms
17. Diagnosed Disability:

EMERGENCY CONTACT INFORMATION

1. First Name:
2. Last Name:
3. Home Phone Number:
   Format: xxx-xxx-xxxx
4. Cell Phone Number:
   Format: xxx-xxx-xxxx

PARENT OR GUARDIAN - for participants under 18

1. First Name:
2. Last Name:
3. Home Phone Number:
   (xxx-xxx-xxxx)
4. Work Phone Number:
   Format: xxx-xxx-xxxx
5. Cell Phone Number:
   Format: xxx-xxx-xxxx
6. E-mail address:
   Example: john2345@aol.com
7. Address:
8. Relationship:

COMMENTS & SUBMIT

1. Comments: