Sigma 24 Hours of DINO
Entry Form 2006
ENTRY FEES per
person
24 Hr Solo: $120
after Sept 15:
$125
race weekend: $130
12 Hr Solo: $70
after Sept 15: $75
race weekend: $80
6 Hr Solo: $50
after Sept 15: $55
race weekend: $70
24 Hr Team: $100
after Sept 15:
$105
race weekend: $110 per person
12 Hr Team: $60
after Sept 15: $65
race weekend: $70 per
person
NORBA one-day permit: add $5 per
person
(required of all riders who are not members of NORBA)
ALL RIDERS MUST
SIGN A LIABILITY RELEASE FORM AT THE RACE VENUE. No refunds after September
15.
Mail entry with
check payable to: DINO
Or register online
at www.active.com
DIVISION (Circle one):
24-hour 1MA,
1WM, 2MA, 2CO, 2WM, 4MA, 4WM, 4CO, 4BG, 6MA, 6WM, 6CO, 6BG, SS
12-hour 1MA, 1WM, 2MA, 2CO, 2WM, 4MA, 4WM,
4CO, 4BG
6-hour 1MA, 1WM
NUMBER OF RIDERS ON
TEAM: __
Mail all team
members entry forms together. Enter the same team name in TEAM/SPONSOR blank
below.
NORBA LICENSE TYPE: ANNUAL___ 1-DAY
PERMIT___ ($5)
If Annual: LICENSE#: |__|__|__|__|__|__|__|__| EXP. DATE: |__|__/__|__/__|__| AGE: _____ SEX: M__
F__
LAST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
FIRST NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
STREET ADDRESS: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
CITY:
ZIP: |__|__|__|__|__| PHONE#: (____)|__|__|__-__|__|__|__|
E-MAIL: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
T-SHIRT SIZE:
S___ M___ L___ XL___
Extra Meals For Spectator(s)
$8 each. Indicate quantity: Saturday___ Sunday___
EMERGENCY CONTACT
INFO:
NAME: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
PHONE#: (____)|__|__|__-__|__|__|__|
or SPECTATOR AT THE EVENT ___
OPTIONAL:
TEAM/SPONSOR: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|
OCCUPATION: _______________ TIDBIT
ABOUT YOURSELF: _____________________________