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Get Usa Cycling 2012 Release Form

ONE DAY AND WAIVER 2012 USA Cycling Release Form AND One-Day License Application - Road/Track/Cyclocross Competitive Event or Gran Fondo Event ONE-DAY PAYMENT INFORMATION CASH OR CHECK ACCEPTED no credit cards 10 PER DAY Amount Paid One-day Cat R/T 5 men 4 women CX 4 all Event Date s Authorized Personnel Initials PLEASE COMPLETE THE FOLLOWING INFORMATION TODAY S DATE EVENT NAME EVENT DATE S RACE S /ACTIVITY IES ENTERED RACING AGE as of December 3.

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