2025 Limited Event Verification Form

2025 Limited Event Verification Form
Form Instructions

Please read and complete ALL information and sections of the online form for successful submission.

Information Required For Online Submission
The following information is required to complete the Limited Events Verification Form online:
1. Athlete Information
  - First & Last Name
  - Mailing Address
  - Email
  - Phone
  - Gender
  - Date of Birth
  - Emergency Contact, Relationship, Phone Number
2. Copy of PHOTO ID with DATE OF BIRTH will need to be uploaded in order to verify age (file types accepted: pdf, doc, docx, jpg, jpeg, png).
3. Copy of Official Event Results or other public document illustrating the results will need to be uploaded to verify participation (file types accepted: pdf, doc, docx, jpg, jpeg, png).
Acknowledgement is required to proceed.*

I have read and am aware of the Information Required For Online Submission. I am prepared to complete the form.

Age Eligibility, Qualifying Period & Rule D-Qualification For Limited Events
AGE ELIGIBILITY

Athletes must be at least 50 years of age on or before December 31, 2024 to be eligible for the 2025 National Senior Games.

QUALIFYING PERIOD

The qualifying period for the 2025 National Senior Games runs from January 1, 2024 through December 31, 2024.

Competition completed after December 31, 2024 will not be considered for 2025 National Senior Games qualification.

Rule D. QUALIFICATION FOR "LIMITED" EVENTS

The NSGA defines a "limited" event as one in which an athlete can qualify in ways other than by participating in a Qualifying State Senior Games. Events that are considered "limited" are 20K and 40K cycling, hammer throw, pole vault, 5K/10K road race, triathlon and the following non-ambulatory sports: bowling and shuffleboard. The qualification rules for these events are as follows.

1. If a "limited" event (except triathlon) is offered at the Qualifying State Senior Games in an athlete's home state, the athlete must qualify for that event by participating at a Qualifying State Senior Games and by satisfying the qualification standards for the event.

2. If a "limited" event is NOT offered at the Qualifying State Senior Games in an athlete's home state, the athlete may qualify for the respective event by meeting the following criteria:

a. For 20K or 40K Cycling Road Race an athlete must submit verification of having completed one cycling road race of the event length or better, between January 1 and December 31, 2024. An athlete qualifying in either of the Cycling Road Races (20K and 40K) is reciprocally qualified in the other.

b. For 5K and 10K Road Race an athlete must submit verification of having completed one 5K or 10K event between January 1 and December 31, 2024. An athlete qualifying in either the 5K or 10K Road Race is reciprocally qualified in the other distance.

c. For Pole Vault an athlete must submit verification of having met the NSGA minimum performance standard for pole vault at any USA Track & Field sanctioned competition between January 1 and December 31, 2024.

d. For Hammer Throw an athlete must submit verification of having competed in one USA Track & Field sanctioned competition between January 1 and December 31, 2024.

e. For Triathlon an athlete must submit verification of having completed one triathlon between January 1 and December 31, 2024. All triathletes have the opportunity to qualify under the "limited" event criteria, regardless of the Qualifying State Senior Games in the athletes home state offering the event.

f. For Non-ambulatory Bowling and Non-ambulatory Shuffleboard an athlete must submit verification of having competed in one non-ambulatory competition between January 1 and December 31, 2024.

March 15, 2025 is the deadline to submit Limited Event documentation to NSGA.

Submissions must include: 1) Limited Event Verification Form; 2) Copy of official event results or other public document illustrating the results; and 3) COPY OF PHOTO ID with DATE OF BIRTH.
Acknowledgement is required to proceed.*

I have read and understand the the parameters of Age Eligibility, the Qualifying Period and Rule D-Qualification For Limited Events.

Results Documentation Required for Limited Event Verification

Sport/Event		Limited Event Qualifying Results Requirement
Cycling
	20K Road Race	Verified completion of ONE 20K race during the qualifying period.*
	40K Road Race	Verified completion of ONE 40K race during the qualifying period.*
Non-Ambulatory
	Bowling	Verified completion of ONE non-ambulatory Bowling event during the qualifying period.*
	Shuffleboard	Verified completion of ONE non-ambulatory Shuffleboard event during the qualifying period.*
Road Race
	5K	Verified completion of ONE 5K race during the qualifying period.*
	10K	Verified completion of ONE 10K race during the qualifying period.*
Track & Field
	Hammer Throw	Verified completion of ONE USA Track & Field sanctioned Hammer Throw competition during the qualifying period.*
	Pole Vault	Verified jump at a USA Track & Field sanctioned competition during the qualifying period* that meets the MPS for your age/gender division. (See NSGA Official Sport Rules for Minimum Performance Standards)
Triathlon		Verified completion of ONE triathlon during the qualifying period.*
* The Qualifying Period for the 2025 National Senior Games is January 1 - December 31, 2024.

Acknowledgement is required to proceed.*

I have read and understand the Results Documentation Required for Limited Events Verification .

Section I: Athlete Information

Section I: Athlete Information
ATHLETE FIRST & LAST NAME*

First NameLast Name
MIDDLE INITIAL
Middle Initial
PREFERRED FIRST NAME / NICKNAME
GENDER*

FEMALEMALE
DATE OF BIRTH*

MonthDayYear
To qualify for the 2025 National Senior Games an athlete must be at least 50 years of age by 12/31/2024.
EMAIL*
example@example.com
IS YOUR MAIN PHONE NUMBER AN INTERNATIONAL PHONE NUMBER (OUTSIDE OF THE UNITED STATES)?*

YesNo
MAIN PHONE NUMBER (INT'L)*

Country CodeArea CodePhone Number
MAIN PHONE NUMBER*
Please enter a valid phone number.
IS MAIN PHONE A CELL PHONE?*

YesNo
CELL PHONE NUMBER
If you have a Cell Phone please provide a valid cell phone number.
MAILING ADDRESS*

Street Address

Street Address Line 2

CityState / Province Abbreviation

Postal / Zip CodeCountry
COPY OF PHOTO ID with DATE OF BIRTH must be submitted to verify age division. UPLOAD HERE:*

File types accepted: pdf, doc, docx, jpg, jpeg, png
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Emergency Contact Information
EMERGENCY CONTACT NAME*

First NameLast Name
RELATIONSHIP*
PHONE NUMBER*
Please enter a valid phone number.

Section II: Event Information

Section II: Event Information
Select the Limited Event(s) for which you are submitting results.*

Cycling - 20K Road RaceCycling - 40K Road RaceRoad Race - 5KRoad Race - 10KT&F - Hammer ThrowT&F - Pole VaultTriathlonNon-Ambulatory BowlingNon-Ambulatory Shuffleboard

PROVIDE EVENT DETAILS
Provide information about the event you participated in to achieve the results you are submitting.

CYCLING -20K ROAD RACE
NAME OF EVENT*
DATE OF EVENT*

MonthDayYear
Date
NAME OF EVENT DIRECTOR OR HOST ORGANIZATION*
PHONE # OF EVENT DIRECTOR OR HOST ORGANIZATION*
20K ROAD RACE - TIME FINISHED*
Enter HH:MM:SS.cs (i.e. 01:31:09.40)

CYCLING - 40K ROAD RACE
NAME OF EVENT*
DATE OF EVENT*

MonthDayYear
Date
NAME OF EVENT DIRECTOR OR HOST ORGANIZATION*
PHONE # OF EVENT DIRECTOR OR HOST ORGANIZATION*
40K ROAD RACE - TIME FINISHED*
Enter HH:MM:SS.cs (i.e. 01:45:29.30)

ROAD RACE - 5K RUN
NAME OF EVENT*
DATE OF EVENT*

MonthDayYear
Date
NAME OF EVENT DIRECTOR OR HOST ORGANIZATION*
PHONE # OF EVENT DIRECTOR OR HOST ORGANIZATION*
5K RUN - TIME FINISHED*
Enter HH:MM:SS.cs (i.e. 00:59:01.23)

ROAD RACE - 10K RUN
NAME OF EVENT*
DATE OF EVENT*

MonthDayYear
Date
NAME OF EVENT DIRECTOR OR HOST ORGANIZATION*
PHONE # OF EVENT DIRECTOR OR HOST ORGANIZATION*
10K RUN - TIME FINISHED*
Enter HH:MM:SS.cs (i.e. 01:02:45.01)

TRACK & FIELD - HAMMER THROW
NAME OF EVENT*
DATE OF EVENT*

MonthDayYear
Date
NAME OF EVENT DIRECTOR OR HOST ORGANIZATION*
PHONE # OF EVENT DIRECTOR OR HOST ORGANIZATION*
HAMMER THROW - DISTANCE THROWN*

TRACK & FIELD - POLE VAULT
NAME OF EVENT*
DATE OF EVENT*

MonthDayYear
Date
NAME OF EVENT DIRECTOR OR HOST ORGANIZATION*
PHONE # OF EVENT DIRECTOR OR HOST ORGANIZATION*
POLE VAULT - HEIGHT CLEARED*

TRIATHLON
NAME OF EVENT*
DATE OF EVENT*

MonthDayYear
Date
NAME OF EVENT DIRECTOR OR HOST ORGANIZATION*
PHONE # OF EVENT DIRECTOR OR HOST ORGANIZATION*
TRIATHLON - TIME*
Enter HH:MM:SS.cs (i.e. 02:27:31.00)
TRIATHLON - RUN DISTANCE *
Must be at least 5K or 3.1 Miles
TRIATHLON - RUN TIME*
Enter HH:MM:SS.cs (i.e. 00:29:55.30)
TRIATHLON - BIKE DISTANCE*
Must be at least 20K or 12.4 Miles
TRIATHLON - BIKE TIME*
Enter HH:MM:SS.cs (i.e. 00:35:02.80)
TRIATHLON - SWIM DISTANCE*
Must be at least 400 Meters or 500 Yards
TRIATHLON - SWIM TIME*
Enter MM:SS.cs (i.e. 07:18.05)

NON-AMBULATORY BOWLING
NAME OF EVENT*
DATE OF EVENT*

MonthDayYear
Date
NAME OF EVENT DIRECTOR OR HOST ORGANIZATION*
PHONE # OF EVENT DIRECTOR OR HOST ORGANIZATION*

NON-AMBULATORY SHUFFLEBOARD
NAME OF EVENT*
DATE OF EVENT*

MonthDayYear
Date
NAME OF EVENT DIRECTOR OR HOST ORGANIZATION*
PHONE # OF EVENT DIRECTOR OR HOST ORGANIZATION*

Upload Results
COPY OF RESULTS for the completed event(s) must be submitted to verify participation. UPLOAD HERE:*

File types accepted: pdf, doc, docx, jpg, jpeg, png
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Section III: Certification by Athlete

Section III: Certification by Athlete
CERTIFY YOUR SUBMISSION*

I verify that the information on this form is accurate.
SIGNATURE OF COMPETITOR*

Clear
TODAY'S DATE*

MonthDayYear
Date
Should be Empty:

2025 Limited Event Verification Form

Section I: Athlete Information

Section II: Event Information

Section III: Certification by Athlete