L1.p1/12.15.06                                                  Date Submitted                                            Date Approved                                

UNITED STATES ORIENTEERING FEDERATION

APPLICATION FOR RETROSPECTIVE ACCREDITATION

LEVEL 1

1. IDENTIFICATION

Name:                                                                                                 Age                  Club                                                          

Address:                                                                                              Phone (              )                                                   (Home)

                                                                                                           Phone (              )                                                     (Work)

Type of employment:                                                                                            Birthdate:                                                        

Number of years orienteering:

Member of USOF?     NO                               YES                Since                          USOF #                                            

2. EXPERIENCE (List dates, places, people. Use back of sheet if needed.)

O Involvement:

O Participation:

Other Sports Involvement (participating or coaching):

Major O Event results:

Coaching in O Sport: