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This form will be submitted directly to Head Coach of Cycling Ric Damm

PERSONAL INFORMATION
First name: Last name:
Address:

City: State:
Country: Zip:
Phone: ( ) - E-mail:
Mother's Name: Her Occupation:
Father's Name: His Occupation:
    Living With:
ACADEMIC INFORMATION
High school: Grad year:
ACT score: Class rank:
SAT verbal: Class size:
SAT math: GPA:
Possible academic major:

Check to indicate undecided at this time.

ATHLETIC INFORMATION
Are you currently a member of or have you participated on a high school cycling team?
If yes, name of high school coach:
Are you currently a member of or have you participated on a shop or other sponsored team?
If yes, name of shop or team:
Do you currently or have you held a USA Cycling license? If yes, select type(s) below.

Please list your top five results in the fields below. Or email your race resume to dammr@ripon.edu.

Please include event name, date, location, category, distance, field size and any other information you feel pertinent:

1.
2.
3.
4.
5.
Please list any honors or recognition you've earned as a cyclist: