Olympia Orthopaedic Associates/ CBC Racing Cycling Team - 2019
Welcome cyclists! Thanks for helping us collect information about you during the registration process for the 2019 Olympia Orthopaedic Associates/CBC Racing Cycling Team.

If you encounter any problems with this form, please email Andy Rosser directly for assistance (andymanr@gmail.com)

First Name *
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Last Name *
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Street Address 1 *
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Street Address 2
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City *
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State *
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Zip *
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Contact Phone # *
XXX-XXX-XXXX
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Email *
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ReEnter Email *
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Birthdate *
MM/DD/YYYY
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DD
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YYYY
Gender *
Emergency Contact Name *
(First Last)
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Emergency Contact Phone # *
XXX-XXX-XXXX
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Are you a New or Returning member? *
USAC License #
If you don't have a USAC License you may get one later at www.usacycling.org
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