2019 UCI Pan Am Road Championships Discretionary Athlete Nomination

Use this form to petition for the 2019 UCI Pan Am Road Championships
May 2-5, 2019 - Zacatecas, Mexico

First Name

Last Name

Phone Number

Address

City

State

Zip Code

Emergency Contact Name

Emergency Contact Number

Date of Birth

USAC License Number

UCI 11 Digit Code

Road Race

Time Trial

If you have any questions about the petition process, please contact Scott Schnitzspahn at sschnitzspahn@usacycling.org.