GONE RIDING, Inc

PRE-ENTRY FORM (This form is not a release)

All pre-entries must be received on designated date on flier to be eligible for discounts.

Date:______________ Please Print Clearly

First Name:_______________________________________ Last Name:_______________________________________

Address:_________________________________________

City:_____________________________________________ State:_____________ Zip:_______________

Phone:___________________________________________

E-Mail address:____________________________________

Age:_______________ Birth Date:__________ Gender:____________

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Race Date:_______________________________________ Race Series:______________________________________

Race Location:____________________________________ Class:___________________________________________

Norba #:_________________________________________

Sponsor:_________________________________________ Bike Brand:_______________________________________

Costs:

See race flier for pricing

Amount enclosed:_____________

GONE RIDING, Inc. / 10915 SW 58^th Ave. Road / Ocala, Florida 34476 / (352) 873-9279