NOTES:

  1. There is a mandatory $80 grounds fee.

  2. There are no refunds once a form is submitted.
 
  Rider Information:
Member Number:
Expire Date (mm/yy):
Affiliate/Country Membership:
Ski Classification:
Runabout Classification:
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Country:
Email Address:
 Verify!!! (no www., etc)
Phone Number:
Social Security #. US Only:
Emergency Contact :
Emergency Phone :
Emergency Contact On Site:
Medical Insurance Provider:
Medical Provider Phone:
Policy Number :
Date of Birth (mm/dd/yy):
Where do you anticipate to stay during the WF?
Sponsor 1:
Sponsor 2:
Sponsor 3:
 
   Entry Fees:
 
   Closed Course/Freestyle/Endurance Entry Info:
     CC/Freestyle Brand Race No
    
    
    
    
    
 
   SLALOM WORLD CHAMPIONSHIP Class and Entry Info:
     Slalom Brand Race No
    
    
    
     * See Online for requirements ** Requires Approval.
   Qualifying Information:
Please list at least 2 qualifying races (date, region, promotor):
 
   Pass Authorization:
Each Closed Course rider receives three (3) wristbands which allow access to the pits - one for the rider, and two for their pit crew. Up to four additional passes are available at the race site, two of these will be available at a discounted rate. If you would like to authorize someone to pick up wristbands/vouchers and/or parking pass on your behalf, please indicate the name of the individual and what they are authorized to pick up. Slalom only entries receive one (1) wristband and an upper parking pass which is good for pit parking on Slalom Competition day only.
Authorized Person:
Wristband/Vouchers:
Parking Pass:
 
   Payment Information:
Method of Payment:
Credit Card Number:
Expiration Date:
Credit Card Billing Zip:
Cardholder Name:
Three Digit Security Code (see back of card):