Name: __________________________________ |
Phone: (Day) ________________________ Phone: (Eve) ________________________ E-mail: ______________________________ RUSA member Nr: _________
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I will have a support crew. | 1200km (US$150 base fee), or | |
I am a UMCA Ultracycling Cup participant. | 1000km (US$150 base fee), and/or | |
I am attempting to qualify for RAAM. | 200km (no fee). | |
Single bike Tandem, partner: _____________________ |
Distance | Date | Location | Elapsed Time | Certificate Nr. |
200km | ||||
300km | ||||
400km | ||||
600km | ||||
or 1000km | ||||
Front - click to enlarge |
| Back - click to enlarge. |
Payment - by check or money order - is due with this application.
If paying in foreign currency, calculate your US$ amount, including the $10 surcharge, multiply by the exchange rate, and send that sum. For example, payment of the $150 base fee in Canadian dollars would be (US$150 + $US10) x 1.22 = 195.20 Canadian dollars. Cancellations by Aug 1: full refund minus $10; Aug: 50%, Sept. 25%. |
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