TODAY'S DATE: __________________

NAME (print): ___________________________________________

STREET: ____________________________________________________

CITY, STATE, ZIP: _____________________________________________

RIDER PHONE #: _____________________ WORK #: ___________________

LICENSE#: ______________________   SOCIAL SEC. #________________________

TEAM NAME: ________________________________________________

RACING AGE: ___________		CATEGORY: _________

WHO TO NOTIFY IN CASE OF EMERGENCY: ___________________________

	PHONE #: _____________________


All award checks will be mailed with in 30 days after the final day of the racing, August 1, 2006
  
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IF MAILING IN YOUR REGISTRATION, THIS FORM AND A U.S. MONEY ORDER 
MADE OUT TO "THE INTERNATIONAL" CAN BE SENT TO THE ADDRESS ABOVE.
NO CHECKS ACCEPTED.

REGISTRATION FEES:

______Masters 35+  -  $30.00 




**No Registration Refunds**