TODAY'S DATE: ______________

NAME (print): ________________________________________

ADDRESS: ____________________________________________________________

CITY, STATE, ZIP: _____________________________________________

RIDER PHONE #: _______________  WORK #: ______________

LICENSE#: _______________ SOCIAL SEC. #: _______________

TEAM NAME: ___________________________________________

RACING AGE: _________

WHO TO NOTIFY IN CASE OF EMERGENCY: _______________________________

	PHONE #: _______________


REGISTRATION FEES:

_______Men Category 2  -  $90.00
_______Men Category 3  - $90.00
_______Men Category 4  - $90.00
_______Women Category 3  - $90.00
_______Women Category 4  - $90.00

All award checks will be mailed within 30 days after the final day of racing, July 31, 2005
______________________________________________________________________________

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.

**No Registration Refunds**