Health Information
Please complete the following registration form

At the end of the registration you will be forwarded to the testing site.

Athlete Information:

Name:
Date of Birth  /  /   (ex: mm/dd/yyyy)
Gender:
Street Address:
City:
State:
Zip:
Email:
Confirm Email Address:
Home Phone:
School / Organization:
Current Sport:
Current Position:

Payment Information - The Baseline Test Fee is $10.00

Card Type
Card Number

CVV Number
Card Holder
Expiration Date  /
 


Security Information

All transactions are completed on our secure server. In secure mode, your computer and our server begin communicating, sending data back and forth in an encrypted format. The encryption features of browser software are exceptionally powerful and ensure the security of this data as it is transmitted to our server.
 
A browser in secure mode will display a URL address beginning "https://" rather than the standard "http://". The "s" stands for "secure." In Netscape Navigator (versions 3.0 and earlier), the broken key symbol in the lower left corner of your browser window will become a solid key in secure mode. If you're using Netscape Communicator 4.0 or higher, look for the padlock in the same space: it's open in standard mode and closed in secure mode. In Microsoft Internet Explorer, you'll see a padlock symbol at the bottom of your browser window when the browser is in secure mode.