In an attempt to reduce paper work and postal fees, 2009 Registration Forms will only be
accepted via On-line transmission. Please type over the pre filled information.
Athlete First Name                                                                         Athlete Last Name                                                       MI
Address                                                                                            City                                                                              ST
Zip Code                                    Home Telephone #                                 (MM)      (DD)        (Year)                               
Parental Information
Parent/Guardian Name                                                                       Relationship to Athlete?                           
Parent  Address                                                                                City                                                                          ST
Zip Code                                    Home Telephone                                      Email Address
Employer                                                                                                        Work Telephone #
Medical/ Insurance  Information
Insurance Carrier Name                                                                                 Policy Number
Physician Name                                                                                              Telephone #
Emergency Contact Name:                                                                             Emergency Contact Telephone #
Relationship to the Athlete
Participation/Registration Level
Please indicate the appropriate registration level.
You may only select one option. The registration
level will determine the fee associated with
participation. Upon receipt of fees the registered
athlete will become a member of the Carolina
Eagles Track Club.
Other Information
I acknowledge review of the "2009 Preview" and commit to the policies and procedures as outlined.
In consideration for allowing the above named individual to participate in club activities and use the
facilities, I acknowledge that there may be some risks involved.  I hereby release the Carolina Eagles
Track & Field Club, Inc., it's coaches, manager, officers, agents and sponsors from any liability for
injuries suffered by the named individual while under the instruction, supervision, or control of or upon
the premises used by the Carolina Eagles or such other premises as may be used in its operation or
programs, including transportation to and from activities: and I agree not to sue for any such injury.  I
agree to provide for any medical expenses incurred by named individual as a result of any injury
sustained while training or performing for the Carolina Eagles.
Upon submission of  this registration form I acknowledge financial responsibility for the FEE
associated with PARTICIPATION and will make payable such fees via US Postal Service. (NO CASH or
PERSONAL CHECKS - Only CERTIFIED CHECKS or MONEY ORDERS will be accepted).
The Carolina Eagles Track Club does not discriminate based on athletic ability, race, sex , religion or
socio-economic background. However, in recent years our enrollment numbers have increased
tremendously. In an attempt to ensure quality training and development the organization may option to
suspend registration in advance if registration numbers reach unmanageable levels.

Please submit your registration form as soon as possible to ensure membership for the 2009 Season.