Va Form 0926a - National Veterans Golden Age Games Athlete Registration Checklist - 2012

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OMB Number: 2900-0759
Respondent Burden: 20 minutes
2012 NATIONAL VETERANS
GOLDEN AGE GAMES
ATHLETE REGISTRATION CHECKLIST
REGISTRATION DEADLINE IS FEBRUARY 29, 2012
NAME
ATHLETE FORMS
VA FORM 0926b
ATHLETE APPLICATION AND EVENT SELECTION
VA FORM 0926c
MEDIA AND NEWS RELEASE
VA FORM 0926d
WAIVER AND RELEASE OF LIABILITY
VA FORM 0926e
MEDICAL APPLICATION
VA FORM 0926f
ALTERNATE ACTIVITIES
VA FORM 10-3203
CONSENT FOR USE OF PICTURE AND/OR VOICE
VA FORM 10-5345
REQUEST FOR AND AUTHORIZATION TO RELEASE MEDICAL RECORDS OR HEALTH
INFORMATION
CURRENT EKG REPORT
CURRENT MEDICATION PROFILE
CURRENT SLEEP STUDY (If using BIPAP/CPAP)
PLEASE ASK YOUR COACH OR MEDICAL CENTER STAFF TO REVIEW THIS
CHECKLIST WITH YOUR ATTACHED FORMS PRIOR TO MAILING.
The NVGAG Website, event rules, and information can be found on the internet at:
REGISTRATION DEADLINE IS FEBRUARY 29, 2012
PLEASE RETURN COMPLETED PACKETS TO:
Administration Subcommittee
2012 National Veterans Golden Age Games
St. Louis VAMC
1 Jefferson Barracks Dr. 128/JB
St. Louis, MO 63125
FAX: 314-894-6114
0926a
VA FORM
OCT 2011

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