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DIRT WEEKEND - REGISTRATION FORM

Full Name: Nickname:
Birthday: Age: Gender: M F
Address:
Contact No: Email:
Bike Club/Organization/Affiliation:
ID Submitted:


Person to notify in case of emergency
Name: Contact Number: Relation:


Please put a check mark in your event:

CROSS COUNTRY (XC) FOUR CROSS (4X) DIRT JUMP (DJ)
Open/Elite
Youth (15-19yo)
Sport (20-29yo)
Executive (30-39yo)
Masters (40 up)
Womens
Kids (14 below)
Beginners (1st time Racers)
Open/Elite
Intermediate
Beginners
Masters
Womens
Kids (14 Below)
MTB Open
BMX Open


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