Name
Address
City State
Postal Code
Country
Home Phone
E-mail account
Birthdate: mm dd
yy
(select) Male Female
Ultracycling Cup events already ridden this year
If the Ultracycling Cup participant is a minor, then print this form and the parent or guardian must sign the statement below the Submit Form button.
I agree that _________________________ (name) can participate in the Ultracycling Cup and I have read and signed his/her UMCA membership form.
(Signed) ______________________________ (Date) _______________
If you are already a UMCA member to register either