Fat Frogs Racing

2007 Race Membership Application

 

Are you a new member or renewing your membership?  (Circle One)

 

New                             Renewal

 

1. Personal Information

 

Please print or type name. 

 

Name:

 

Address:

 

City:

 

State:

 

Zip Code:

 

Email:

 

Home Phone:

 

Cell or Work Phone:

 

 

2. Racing Information

 

Birthdate:

            /            /

Racing Age in 2006:

 

 

 

           (Racing Age = Age on December 31, 2007)

 

Directions to apply for a USCF License:

1.        Go to the following website:   http://www.usacycling.org

2.        On Left column of page under Membership, click the red button titled ‘How to Join USA Cycling’

3.        Then, ‘Create an Account’ (you will not have a license number, leave that blank)

4.        After you click ‘Continue’ it will say you are not currently in the USA Cycling system.  Fill out the form to create a new account.  Then click ‘Continue’.

5.        To “activate” your newly created account, You MUST follow the instructions on the “Confirmation E-mail” that is sent to you.

6.        After you have created an account you can apply for your license.

7.        Log into USA Cycling.

8.        Scroll down the page to the “License Information” section & click “Purchase New License”. (For first time racers: Men will be Category 5 & Women will be Category 4. This applies to Road & Track. Men’s Cyclocross category will be Category 4. You will get all three of these licenses at the same time.)

9.        Until you receive your license in the mail you can print an “Authorization to Race”.
 
 

 

 

 

 

 

 

 

 

 


USCF License Number:

 

(if possible, include a copy of license)

USCF Expiration Date:

         /           /

Road Racing Category:

 

NORBA License Number:

 

(if applicable)

NORBA Expiration Date:

         /           /

 

 (over please)

Uniform Information:

 

Please provide your size(s) for team clothing.
     (Team clothing made by Louis Garneau.)

(At least a short sleeve jersey is required)

Short Sleeve Jersey:

XS

S

M

L

XL

XXL

Quantity:

 

Team Shorts:

XS

S

M

L

XL

XXL

Quantity:

 

Skin Suit:

XS

S

M

L

XL

XXL

Quantity:

 

 

 

 

 

 

Already have team clothing:

 

 

3. Emergency Information:

 

In case of emergency, who can we contact?

Name:

 

City:

 

State:

 

Contact Number:

 

Relationship:

 

 

4. Assumption of Risk

 

ALL RIDERS MUST SIGN ASSUMPTION OF RISK FORM

 

Note:  Persons riding under the age of 18 must be accompanied by a responsible adult.  This statement must be signed by the participant or by the participant’s parent, if the participant is under the age of 18.

 

In consideration of Fat Frogs Racing (FFR) accepting my application, I realize there are certain dangers inherent in the sport of bicycling, and I assume these risks with full understanding that serious injuries, even death, may result from my participation in FFR sponsored events.  I certify that my bicycle is suitable for safe use, and that I am in good physical condition.  I agree to wear an ANSI or SNELL approved helmet and to obey all traffic laws at all times during FFR sponsored events.  I have read this assumption and fully understand its terms.

 

Signature:

 

Date:

 

 

Race Team Membership Fee:  $20 per year

 

Mail Fat Frogs Racing Team Membership Application with $20 to:

 

Fat Frogs Racing Team

c/o Danielle Craven

2524 Castle Hill Court

Virginia Beach, VA 23454

Tel: (757) 301-3696

 

***Please feel free to call if you have any questions regarding any portion of this form.***