Order MUST Accompany Entry                                                                             Official Use Only:

  Mail Entries  Payable to: NJ AAC                P.O. Box 1374, Somerset, NJ 08875-1374                          Bib # ________

  _________________________  __________________________  ______    ___/___/____

  Last Name                                                               First Name                                                           M / F                Birth Date

 

  _________________________________________     (______) _______-______________

  Street Address    (w/Apt. No.)                                                                               Area Code                Phone

  ________________________      ___________    _________________________________

  City                                                                          State                             County of Residence

  _________________________________  _____________________     ________________________________________

                     2010 AAU #                                      2010 Club #                          Exact Name of AAU Club –Otherwise Leave Blank

  In consideration for my entry being accepted, I am intending to be legally bound, for Myself, My Heirs, Executors,
 Administrators, Amateur Athletic Union (AAU), NJ AAU, NJ Athletic Administrative Club, The Green Streakers of
 NJ Track Club, The City of New Brunswick, Meet Volunteers or any Support Groups or Organizations, their respective
 Officers or Agents and/or assigns for any and all damages that may be sustained and suffered by the Athletes in
 connection with their association with or which might arise out of traveling to participating in, or returning from the
 scheduled events.

   _______________________________________________  _____________________________________________________________

  Signature of Athlete                                            If under 18yrs. Signature of Parent/Guardian (NOT COACH)