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:
ZIP: |__|__|__|__|__| PHONE#: (____)|__|__|__-__|__|__|__|
E-MAIL: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
OPTIONAL:
SHIRT,
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 |
|
|
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;
Or register online at www.DINOseries.com