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Address: _____________________________________________________ Phone: _______________________________________________________ E-mail Address: _______________________________________________ Age as of Sept 7th, 2003:________________________________________ Sex: M / F (circle one) Racing Category: ______________________________________________ Team/sponsor (if applicable): ____________________________________ Contact in Case of Emergency: Name: _______________________________________________________ Phone #: _____________________________________________________ Relationship:_________________________________________________ T-Shirt Size: S M L XL (circle one) AMOUNT ENCLOSED: ___________________ |