Name_________________________________________________________________________
Address_______________________________________________________________________
City______________________________________State________________Zip______________
Home Phone____________________________Email___________________________________
Emergency Contact_______________________________________________________________
Emergency Phone #______________________________________________________________
Age (as of 12/31/08)_______________________Date of Birth____________________Sex (M F)
Saturday: Pro/Open $25, Amateur $15, Jr. $10 | Sunday: Pro/Open $35, Amateurs $25, First Timer/ Jr. $15
Check catagory and age
_____ Pro
_____19-29
_____Open
_____30-39
_____Expert
_____40-49
_____Sport
_____50+
_____Beginner
_____Clydesdale
_____First Timer
_____Singlespeed (Sport)
_____14 & under (beginner)
_____Singlespeed
(Expert)
_____15-18 (beginner)
_____18 & under (sport)
_____18 & under (expert)