Kenda DINO Mountain Bike Series Entry Form 2012

WHICH DATE(S) ARE YOU REGISTERING FOR? ____

DINO PLATE#: |__|__|__|__| (Leave blank if you do not yet have a 2012 numberplate)

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

WAVE (Circle One): Pro/elite1, Cat1 Men, Cat2Open, Cat2 under 29, Cat2 30-39, Cat2 40-49, Cat2 50+, Cat1 Women, Cat2 Women, Cat3 19-29, Cat3 30-39, Cat3 40-49, Cat3 50+, Cat3Junior11-18, Clydesdale, Cat3 Women, Intro, Junior10&under

DATE OF BIRTH: m___/d___/y____ 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, HAT, 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

$20

$65

Cat3  / CLY

$15

$25

$100

CAT2

$20

$30

$130

CAT1

$25

$35

$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 CAP (by Headsweats)

$10

DINO SOCKS (by DeFeet)

Air-e-ator $5       Woolie Boolie $10

 

 

TOTAL PAID: _____

 

2012 Kenda DINO Mountain Bike Series

 

DATE / CITY

1. May 19 Warsaw, IN

2. June 3 Nashville, IN

3. June 16 French Lick IN

4. July 1 North Vernon, IN

5. July 22 Versailles, IN

6. Aug 12 Logansport, IN

7. Aug 26 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.DINOseries.com