New Athlete (Agent Version)

Please fill out this form as completely as possible. THE LISTING IS FREE! Important Note: Do not use the [Enter] key to navigate the form below. Pressing [Enter] will submit your information to us. Navigate the form using the up and down arrow keys and the Tab key, and only press [Enter] or [Submit] when you are ready to send your information.
PART 1: BASIC ATHLETE INFORMATION
First Name:
Last Name (surname):
This Athlete Is:	Active Inactive Retired Has a new contact. Try contacting:
Citizen of:
Date of Birth:	,
City/State of Residence (for locating athletes with no address published):
Competitive Team:
College Competed for (if any):
Athlete Website:

PART 2: AGENT/COACH CONTACT

If you have completed an AGENT DATA SHEET, either on-line or via email or questionnaire, simply enter your name (or Agent Code from a previous Directory, if known) below. If you do not plan to submit an AGENT DATA SHEET or do not wish to have an Agent Listing in the Directory, please provide complete address, phone, and contact information for this athlete.
Check here to confirm that this will be the PRIMARY Contact

Agent/coach name/code only (if Agent Data Sheet has been or will be submitted):
If No Agent Data Sheet will be submitted, fill out the following fields:
Agent Name:
Agent Company:
Full Agent Address:
Agent Phone:
Agent Fax:
Agent Email:
Agent Website:

PART 3: ATHLETE ADDRESS - (Optional--You may supply the athlete's address here if you desire)

The RRM Directory may use the athlete's address below as (check one):
No Athlete Address Provided
Primary Contact (for Publication; Agent/Coach will be listed as Secondary Contact)
Secondary Contact (for Publication; Agent/Coach will be listed as Primary Contact)
Mailing List Only (This address is NOT for Publication; only for RRM Mailing list)

Athlete First Name:
Athlete Last Name (surname):
Full Athlete Address:
Athlete Phone:
Athlete Email:

PART 4: COMPETITIVE DATA

Please provide information regarding this athlete's race performances. Road times must be exact to the second (round up tenths of seconds). Indicate track times with a "t" after the time; altitude times with an "a" after the time. PRs set after information is submitted may be phoned in to 301-320-6865; faxed to 301-320-9164; or emailed to directory@rrm.com.

PART A: LIFETIME PERSONAL RECORDS

	Time	Name of Race	Year
10k:
Marathon:
Other (optional):
Other (optional):

PART B: 3-YEAR PERSONAL RECORDS -- Fastest Performances Since JAN. 1, 2004

	Time	Name of Race	Year
10k:
Marathon:
Other (optional):
Other (optional):

PART 5: CAREER

Please list any accomplishments below, including Race Name, Time, Finish Place and Year for all race results you include. All or some of the material supplied here (including or supplemented by recent results) will be used by the editors in preparing the 25-word "Career" section. If you prefer, you may email your resume to pstewart@rrm.com or fax it to Phil Stewart at 301-320-9164. I Prefer to Email my resume to pstewart@rrm.com (Click here to send the email now) I Prefer to Fax my resume to Phil Stewart at 301-320-9164 My Career Highlights Are Listed Below:
PART 6: INFORMATION ON SUBMITTER
We may need to contact you if we have questions on the information you have provided. Please supply below your name (or agent code) and a phone number or email address where you can be reached. We will not use this information for any other purpose than to contact you regarding questions on your listing.
Your Name:
Your Phone:
Your Email:

Does this athlete receive free equipment or more from a running shoe or apparel company?
YES NO
If YES, from which company:

Please send information on advertising in the 2007 Road Race Management Directory