Georgia Golden Olympics Registration Form
IMPORTANT NOTICE: First time participants must use the mail system as a birthdate verification must accompany the application. The application lists the articles that are acceptable as verification. Also check the schedule on the next page for conflicts before registering on line.
Last Name
Birth Date
First Name
MM/DD/YYYY
Year of Birth
Street Address
Select state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West
Wisconsin
Wyoming
City
State
Zip
Phone
Age
County
(As of 12/31/2022)
(Must be dependent on supportive device-wheelchair,walker, etc.)
Sex
Category
Male
Female
Standing
Sitting
(2X Large - $2.00 fee)
T-Shirt Size
Small
Medium
Large
X Large
2X Large
Email
Athlete Information
Agency Represented
Individual
Bacon County Senior Center
Blakely Senior Center
Dalton/Whitfield Senior Center
Forest Park Senior Center
Gables Academy
Lamar County Senior Center
Moultrie Recreation Department
Rockdale Senior Center
Summer's Landing
Spalding Senior Center
Troup Senior Center
Warner Robbins Seniors
Address
City
County
State
Select state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West
Wisconsin
Wyoming
Zip
Agency Contact
Agency Phone
Agency Contact Information
Emergency Contact First Name
Last Name
Relationship
Spouse
Daughter
Son
Brother
Sister
Friend
Other
Phone
(999)999-9999
Emergency Contact Information
Review the Schedule before selecting the events you want to participate in.
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