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2010 NATC/AMA National Observed Trials Championship Online Entry Form

NOTE: all payments are processed through PayPal. An online entry fee of 3% will be applied to all online transactions. This fee will appear as "shipping" when you checkout.

(* denotes required field)

Rider Profile
First Name: *
Last Name: *
Address1: *
Address2:
City: *
State/Province: *
Zip Code: *
Country: *
Phone:
(ex. 123-456-7890)		 - - *
Email Address: *
Date of Birth:
(ex. MM/DD/YYYY)		 / / *



Entry Class
Class: *
If anyone in your traveling party would like to observe, check here:



Minder Information
Minder First Name:
Minder Last Name:
Minder Address1:
Minder Address2:
City:
Minder State/Province:
Zip Code:
Country:
Minder AMA# (enter 000000 if none):
Minder AMA Expires (enter 00/00/0000 if none): / /
Minder Machine:



AMA Information
AMA# (enter 000000 if none): *
Expires (enter 00/00/0000 if none): / / *
Machine:



Sponsor Information
Sponsor Name:

What is your local club/organization?



Terms of Agreement
I have read and agree to the Terms of Agreement. *



NOTE: all payments are processed through PayPal. An online entry fee of 3% will be applied to all online transactions. This fee will appear as "shipping" when you checkout.

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