USA Cycling Request for Discretionary Athlete Nomination

Event for Consideration: 
Athlete Personal Information:
Name*  
Date of Birth*  
Racing Age*   years old
USA Cycling License Number:*  
UCI Code:*  
Address:*  
City:*  
State:*  
Zip:*  
E-mail Address:*  
Verify E-mail Address:*  
Passport Number:*  
Team Sponsor:*   
BMX Category:*   
Coach Name & Contact Information:*
Current Race Results:*
Current National & UCI Ranking:*
References:*
 
Please enter the above text

 

* Required Field