2003 A.E.M.B.A. Race Entry Form

Sunday, July 6, 2003 Start Time: 10:00 AM

Location: The Happy Homestead Paxinos, PA

Categories:

Mountain bike (Single Loop)

All Single Loop categories start to follow Elite start time.

Proceeds to go to Trail Upgrades

Race Course: Approx. 4-Mile Loop

Helmets required

Registration: Day of Race

Pre-registration forms post marked by June 15th: $5.00; day of race: $7.00 Free for AEMBA Members

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Please complete and mail with check to: D Leshock 30 Lewis Dr Ruckersville, VA 22968

Make checks payable to: D Leshock

First Name M.I. Last Name Age Sex (Circle) Category

__________ ___ _______________ ___ M / F

Street City State Zip

__________________________________________ ___________ ______ _________

Email Address Phone Adult

___________________________________________ _________________

Release must be signed day of race. Riders under 18 whose parent will not be available to sign at race must indicate so here and a release will be sent to you. NO ONE MAY RIDE WITHOUT A SIGNED RELEASE ! Need a release sent? (Circle) Yes / No