KENTUCKY TRACK & FIELD MEET ENTRY FORM

Use separate form for men and women. PRINT NEATLY. Use separate line for each event entered.

Team_______________________ Men or Women Coach________________ E-mail address__________________

Address__________________________________City _________________________State_______ Zip___________

Phone (Day) _________________________ Cell Phone_____________________ FAX Number _________________

For the 60m and 60m hurdles events please use the athlete’s best 100m or 100m/110m hurdle times.

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Best Meet & Date of Entry (FEB 17 DECLARATIONS)

Athlete’s Name (First, Last) Grade Event Performance Best Performance Fee Declare (D) – Scratch (S)

Circle “D” or “S”

_______________________ ______ _____ __________ ______________ $10 D S

_______________________ ______ _____ __________ ______________ $10 D S

_______________________ ______ _____ __________ ______________ $10 D S

_______________________ ______ _____ __________ ______________ $10 D S

_______________________ ______ _____ __________ ______________ $10 D S

_______________________ ______ _____ __________ ______________ $10 D S

_______________________ ______ _____ __________ ______________ $10 D S

_______________________ ______ _____ __________ ______________ $10 D S

4 x 400 __________ ______________ $20 D S

COPY AS NEEDED

4 x 800 __________ ______________ $20 D S

MAIL ENTRIES: Don Weber – Kentucky Milers Club TOTAL ENTRY FEE: $_______

2437 Doubletree Court Checks Payable to: Kentucky Milers Club

Lexington, KY 40514-1465 Entry Fee Must Accompany Entry Form- DEADLINE: FEB 10, 2010

FEB. 17 (by 12:00n) FAX COPY of ENTRY FORM with DECLARATIONS CIRCLED .. FAX # 859-323-0070 or 859-323-0025