2017/18 UCI Cyclo-Cross World Cup Pre-Qualified Start Request

Use this form to request entry to a CX World Cup.

First Name

Last Name

Phone Number

Address

City

State

Zip Code

Emergency Contact Name

Emergency Contact Number

Date of Birth

Racing Age

USAC License Number

UCI 11 Digit Code

Team or Sponsor

If you have any questions contact Marc Gullickson at mgullickson@usacycling.org.