DINO Mountain Bike Series Entry Form 2006

WHICH DATE(S) ARE YOU REGISTERING FOR? ____

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

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

CATEGORY: INTRO____ JR-BEG____ BEGINNER_____ SPORT_____ EXPERT ____ PRO_____ CLYDESDALE_____

AGE: _____ SEX: M__ F__

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: |__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|__|

SHIRT (not included with entry – add $10) SIZE: S___ M___ L___ XL___

OPTIONAL:

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

OCCUPATION: _______________ TIDBIT ABOUT YOURSELF: _____________________________

CLASS	early*	day-of	Season pass
INTRO / JR	$10	$15	$65
BEG / CLY	$15	$20	$100
SPORT	$20	$25	$130
EXPERT	$25	$30	$165
NORBA	Add $5 if you are not a NORBA member		Buy an annual ($60) Or add $35
SHIRT	Add $10		Included!
DINO JERSEY by Pyro Apparel		$40

TOTAL PAID: _____

 DATE / CITY

1. May 6 Warsaw, IN

2. June 3 Bloomington, IN

3. June 17 Portage, IN

4. July 2 North Vernon, IN

5. July 30 Logansport, IN

6. Aug 20 New Castle, IN

7. Sept 9 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.active.com