Kenda DINO Mountain Bike Series Entry Form 2009

WHICH DATE(S) ARE YOU REGISTERING FOR? ____

DINO PLATE#: |__|__|__|__| (Leave blank if you do not yet have a number plate from 2009)

USAC LICENSE# (leave blank if you are not a USA Cycling member): |__|__|__|__|__|__|__|__| EXP. DATE: |__|__/__|__/__|__|

WAVE (Circle One): Pro/elite1, Cat1 Men, Cat2Open, Cat2 under 29, Cat2 30-34, Cat2 35-39, Cat2 40+, Cat1/2 Women, Cat3 19-29, Cat3 30-39, Cat3 40+, Cat3Junior, Clydesdale, Cat3 Women, Intro

AGE: _____ SEX: M__ F__  CATEGORY: ____

LAST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

FIRST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

HAVE YOU ENTERED A DINO MOUNTAIN BIKE IN THE PAST YEAR? No Yes – if yes you may leave lines below blank, unless changed.

STREET ADDRESS: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

CITY: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__| STATE: |__|__|

ZIP: |__|__|__|__|__| PHONE#: (____)|__|__|__-__|__|__|__|

E-MAIL: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

OPTIONAL:

SHIRT, JERSEY, or SOCKS (extra fees – see below) SIZE: S___ M___ L___ XL___

TEAM/SPONSOR: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

OCCUPATION: _______________ TIDBIT ABOUT YOURSELF: _____________________________

CLASS

early*

day-of

Season pass

INTRO / JR

$10

$15

$65

Cat3  / CLY

$15

$20

$100

CAT2

$20

$25

$130

CAT1

$25

$30

$165

USA Cycling

Add $5 if you are not a USA Cycling member

Buy annual lic. ($60)

Or add $5 per race

T-SHIRT

Add $10

Included!

DINO JERSEY (by Pyro Apparel)

$40

DINO SOCKS (by DeFeet)

Air-e-ator $5       Woolie Boolie $10

TOTAL PAID: _____

 DATE / CITY

1. May 2 Warsaw, IN

2. May 31 Nashville, IN

3. June 13 Ft Wayne, IN

4. July 5 North Vernon, IN

5. July 26 Versailles, IN

6. Aug 16 Logansport, IN

7. Sept 6 Indianapolis, IN

 

*Early Entry must be received by the Wednesday before the event.

ALL RIDERS MUST SIGN A LIABILITY RELEASE FORM AT THE RACE VENUE.

$5 NUMBERPLATE DEPOSIT will be required, refunded upon return of number.

Mail entry with check payable to:

DINO, LLC; PO Box 36395; Indianapolis IN 46236

Or register online at www.sportsbase.com