2013 Airdrie Provincials Registration Form
License #
This is the number found on your 2013 license
UCI Code
This is the number found on your 2013 license
Birthdate MM/DD/YYYY
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First Name
Last Name
Club
Select One....
Independent
AIRDRIE BMX
CALGARY BMX
COALHURST BMX
COCHRANE BMX
EDMONTON BMX
LETHBRIDGE BMX
MEDICINE HAT BMX
OKOTOKS BMX
RED DEER BMX
ST. ALBERT BMX
STONY PLAIN BMX
Select a class
Select one...
Junior_
Elite_
5 and Under_
6_
7_
8_
9_
10_
11_
12_
13_
14_
15_
16_
17-24__(males only)
17 & Over_(females only)
25 to 29_
30+_
Cruiser Junior_
Cruiser Elite_
Cruiser 9 and Under_
Cruiser 10 to12_
Cruiser 13 and 14_
Cruiser 15 and16_
Cruiser 17 to 29_
Cruiser 30 to 34_
Cruiser 35-39_
Cruiser 40 to 44_
Cruiser 45+_ (female only)
Cruiser 45 to 49_
Cruiser 50+_
based on your age at December 31, 2013
ABILITY (20" Classes)
>
Novice_
Intermediate_ (Males only)
Expert_
As per your license
Gender
Male
Female
Plate #
The plate number you will be running on your bike for 2013
Days Racing: (choose one)
Both Days
Saturday Only
Sunday Only
Sponsors
Comments
Email
Confirm