Violet Crown

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About you

Gender identityBirth YearHow would you describe yourself?

Your contact information

Phone numberAddressStreet Address, City, State, Zip Code

Emergency contact information

Emergency contact nameEmergency contact phone numberEmergency contact relationship

About your cycling

Weekly cycling hoursAnnual cycling budgetYour primary preferred way to rideYour second most preferred way to rideAre you interested in racing?USAT license numberUSAC license numberI agree to volunteer for at least 2 club-related events in the upcoming year.

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Parent/guardian full nameParent/guardian phone numberParent/guardian email address

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