USATF
CLUB AFFILIATION
CHANGE REQUEST

This form can only be submitted by a parent or guardian of the athlete.
Athlete's Name
Athlete's Date of Birth
Athlete's USATF Number
Change requested by...
(Parent's Name)
Phone
Email
Please change club affiliation...
From (club name):
To (club name):


This request will be submitted to Harry Simonis, USATF-Oregon, 541-504-1077