Application and Contract Form
BICYCLE RACING  
 
ROAD AND TRACK BICYCLE RACING

IT'S FAST, EXCITING, AND GREAT FUN,,,  TRY SOMETHING DIFFERENT THIS SUMMER.

(Juniors) MOST EQUIPMENT IS PROVIDED.  YOU NEED A HELMET, SHOES, 
AND YOUR PARENT'S PERMISSION.

Juniors  -  COST IS  FOR THE SEASON PLUS $35.00 FOR INSURANCE.

Category  1 & 2      RIDERS PAY THEIR APPROPRIATE LICENSE FEES.

Category  3, 4 & 5   RIDERS PAY $20.00 AND APPROPRIATE LICENSE FEES.

USA PISTA ELITE INC. IS ASSOCIATED WITH USA CYCLING, A GROUP A MEMBER OF THE
US OLYMPIC COMMITTEE.

IF YOU WOULD LIKE MORE INFORMATION, FILL OUT THE FORM AND RETURN IT TO US.
USA PISTA ELITE                                                 (Regular Mail)
TEAM APPLICATION AND CONTRACT
493 FRONT ST.
BEREA, OHIO 44017
440) 891-8320                                                                    
(440) 891-9317 FAX
www.pistaelite.com
pistaelite@aol.com

Date:

Applicants Name:

Address & Street
City

State
ZipCode

Phone Number

Height:     
Weight:    
Inseam:    
Shoe Size:
Jersey Size: (S) (M) (L) (XL) (XL&Long)
Parent's Name: If under 18yrs.

Medical Issues or Disabilities ( If any Explain)

 USCF License Number:
Road Catagory:            
Track Catagory:            
Email Address: 

 
In consideration of enjoying the advantages of competing for TEAM USA PISTA ELITE INC.  I promise and covenant to 1) declare my club affiliation with "PISTA ELITE" to USA Cycling, USCF, and the UCI and the only club or team that shall appear  on my license shall be "PISTA ELITE" 2) compete in at least five (5) races in each calendar year I am a team member unless hampered by injury or disability 3) refrain from the use of illegal and/or banned substances and conduct myself with tact, propriety and decorum while representing at all times while a member of the team 4) maintain academic performance which is acceptable to my parents and the officers of USA PISTA ELITE INC. which should generally be understood to be a letter grade "B" average or the equivalent 5) maintain and return in good condition any and all equipment provided to me by the team on or before November 15th of each calendar year or at such time as requested by USA PISTA ELITE INC. 6) furnish a biography and photograph of myself to be used on the team website and report my racing results (photos of event if available) to the team by e-mail within 72 hours of event completion.  I authorize USA PISTA ELITE INC. and /or its sponsors to use my name, results and image as they see fit to promote USA PISTA ELITE INC., its sponsors, or the sport of cycling in general. I understand that bicycle racing is a dangerous sport and the participants sometimes sustain serious or even mortal injuries, I hereby release and hold harmless USA PISTA ELITE INC., its officers, members, and sponsors from any and all liability resulting from any injury I may sustain while training for, competing in, or traveling to or from a bicycle race.


   

THE FOLLOWING FORM BELOW MUST BE FILLED OUT AND MAILED

VIA REGULAR MAIL, OR HAND DELIVERED TO PISTA ELITE.

SIGNATURE

___________________________                Date_______________


SIGNATURE OF PARENT OR GUARDIAN (if Applicant is under 18)

___________________________                Date_______________

Please return to USA PISTA ELITE INC. at 493 Front St., Berea, Ohio 44017 together with:
1) a copy of your USCF license;
2) a copy of your birth certificate;
3) Ten (10) executed Standard Entry and Release forms (available from www.usacycling.org. or we can provide copies).

MEMBERSHIP ACCEPTED

USA PISTA ELITE INC. by _____________________________, its ___________________