Name: __________________________________ |
Phone: _________________________________________ E-mail: __________________________________________ Nationality: _________________________ Birthdate: _____________ Gender:____ RUSA member Nr: _________ Pending
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I will have a support crew. | 1200km or 1000km | |
I am a UMCA Ultracycling Cup Competition participant. | I have completed these 1200k's: ______________________________ | |
I am attempting to qualify for RAAM. | Recumbent Fixed Tandem, partner: ______________________ |
Distance | Date | Location | Elapsed Time | Certificate Nr. | Subst. Dist. |
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 $185 base fee in Canadian dollars would be (US$185 + $US10) x 1.25 = 243.75 Canadian dollars. Cancellations by July 31: full refund less $10; Aug 1-31: 50%, by Sept. 8: 25%. |
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