Name _____________________________________________
Address __________________________________________
__________________________________________________
__________________________________________________
Home Phone _______________________________________
UCSF License # ___________________________________
Racing class _____________________________________
Team Affiliation _________________________________
Total entry fee enclosed:_________________________
Signature:________________________________________
Mail registration form
by August 2, 2003 to:
Hot Sumner
c/o Greg Clark
125 Buchanan Circle
Hendersonville, TN 37075
Make checks payable to:
Tennessee Wheelmen Association