The Dirty Crit- Wildcard Application

Name*

First Last

Age*

Gender*

Male

Female

Phone*

Email*

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Which biking disciplines do you typically race? (Example: Cyclocross, MTB, Road)*

What races have you competed in over the past year? What are your top finishes?*

Do you have experience with features such as berms, jumps etc.? Please explain.*

Are you sponsored?*

Yes

No

Who are your sponsors?*

I understand that this event is inherently dangerous and utilizes a course that was not originally designed for biking.*

I understand

Additional Comments