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TODAY'S DATE:
EVENT NAME:
Pleasant Valley Time Trial Series Plainville Spring Series
EVENT DATE:
RACE ACTIVITY ENTERED:
Individual Time Trial Hill Time Trial Team Time Trial
CLUB/TEAM NAME:
ANNUAL USA CYCLING LICENSE No.:
RACING AGE (as of 12/31/08):
Please provide the following Racer Contact Information:
Name Street Address City State/Province Zip/Postal Code Phone E-mail
Please provide the following Emergency Contact Information:
Emergency Contact Emergency Contact Phone
Securely pay the $10.00 Race Registration Fee by clicking this button: