Steve Buss Memorial Pole Vault Meet

Name *

First

Last

Email *

Division *

Registering as *

If in a club please list club name here

If you are an unattached high school or college athlete please list school here

Height PR or opening height request (NH if you don't have one to list) *

T-shirt size *

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone number

Birthdate *

Liability/media waiver *

I have read & acknowledged the Steve Buss Memorial Pole Vault liability/media waiver

Waiver

Payment awknowledgement *

I have read & acknowledged that pre-registration payment (registered online by Aug 9) is $35.00 (includes T-shirt). Payments can be sent electornically through Venmo to Shawn Buss @Shawn-Buss-1 (memo Memorial Meet) or mailed to Shawn Buss, 712 Westfield Street, Kaukauna, WI 54130