ESC Classic Long Island Team Application

Name:
Street Address:
City:
ZIP code:
Email:
U.S. phone number:	( ) - Second three digits Last four digits
Birthdate:
Current USATF #:
Events:	Please list the events you would like to be considered for. Include season's best mark with the date and location of meet.
Singlet Size:
Affiliation:	School, College or Club. UNA is unattached