2010 USA Cycling Athlete Development Camp Team Entry
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1. 2010 USA Cycling Athlete Development Camp Team Entry

This form is to be filled out by a club/team representative. Riders that are signed up by their club/team to participate in the camps will enjoy a discount of $75. To qualify for the team discount:
1) Three registrants per team, minimum.
2) All riders must be already eligible to participate in the camp program.
3) All riders must be registered, together, by their club/team.
4) Camp registration for the team members must be paid in full and submitted with a printed version of this registration form.
5) The total amount due is $625 per rider if payment is received by April 12; after April 12 the price per rider increases to $675.
6) For payment, you can arrange a time to call Sam Callan at 719.434.4224 for credit card payment over the phone (Mastercard or Visa only). Please call or email (scallan@usacycling.org) to arrange a time so that Sam can review the team/club entry. You can also send a printed copy of this form with check to

USA Cycling
ATTN: Sam Callan
210 USA Cycling Point, Ste 100
Colorado Springs, CO 80919

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1. Please enter club/team information.

Please enter club/team information. club/team name
club/team USACycling number

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2. Please enter your name and your affiliation with this club/team.

Please enter your name and your affiliation with this club/team. affiliation (title)
email:
name
phone:

3. Please enter the names and (license numbers) of all riders.

Please enter the names and (license numbers) of all riders. 1
2
3
4
5
6
7
8
9
10

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4. Are all the athletes above eligible to participate in the Athlete Development Camp? If not, PLEASE DO NOT SUBMIT PAYMENT AND REGISTRATION UNTIL ALL TEAM MEMBERS ARE ELIGIBLE and they can see the sign up link on their MYUSACycling homepage. To request eligibility, please submit a request for eligibility:  http://www.surveymonkey.com/s/2010eligibilityrequest.

NOTE: Credit will not be issued retroactively for team members that paid the full amount.

Are all the athletes above eligible to participate in the Athlete Development Camp? If not, PLEASE DO NOT SUBMIT PAYMENT AND REGISTRATION UNTIL ALL TEAM MEMBERS ARE ELIGIBLE and they can see the sign up link on their MYUSACycling homepage. To request eligibility, please submit a request for eligibility:  http://www.surveymonkey.com/s/2010eligibilityrequest. NOTE: Credit will not be issued retroactively for team members that paid the full amount. yes

notes:

5. by last name, please enter which riders will be attending which camps. Note: teammates do not have to all participate in the same camps to enjoy the team discount.

by last name, please enter which riders will be attending which camps. Note: teammates do not have to all participate in the same camps to enjoy the team discount. South-Central Road Camp, TBD
South-East Road Camp, Furman U, Greenville, SC June 6-11
North-West Road Camp, Pacific University, Forest Grove, OR August 1-6
Mid-Atlantic Road Camp, DeSales University, Center Valley, PA, June 13-19
North-Central Road Camp, UW-Lacrosse, Lacrosse, WI, August 1-6
West Coast Road Camp, St. Mary's College, Moraga CA, July 5-10
South-West Road Camp, Northern Arizona U, Flagstaff, AZ June 13-18
Mid-South Road Camp, St. Mary's Sewanee, Sewanee, TN June 13-18
Rocky Mountain Road Camp, Colorado State University, Ft. Collins, CO, June 7-12
Rocky Mountain XC MTB Camp, United States Olympic Training Center, Colorado Springs, CO June 13-18
Junior Women Specific Road Camp, Blue Ridge Camp, Mountain City, GA, June 6-11
South-East XC MTB Camp, Terra Nova Center, Cedar Mountain, NC June 21-26
Mid-West Regional Track Camp, Marian College, Indianapolis, IN, Date TBD

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6. With one check made out to USA Cycling, please submit $675 per rider prior. Please notify Sam Callan (scallan@usacycling.org) that the team entry has been completed if paying by credit card.

If paying by check mail this form and check to
Sam Callan
210 USA Cycling Point, Ste 100
Colorado Springs, CO 80919

Calculating $675 per rider, how much is enclosed? Credit card payments can be made by entering the credit card number here (Mastercard or Visa only) and expiration date.

With one check made out to USA Cycling, please submit $675 per rider prior. Please notify Sam Callan (scallan@usacycling.org) that the team entry has been completed if paying by credit card. If paying by check mail this form and check to Sam Callan 210 USA Cycling Point, Ste 100 Colorado Springs, CO 80919 Calculating $675 per rider, how much is enclosed? Credit card payments can be made by entering the credit card number here (Mastercard or Visa only) and expiration date.

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7. Is there anything else you would like to add?

Is there anything else you would like to add?

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