tour de Dayton - Registration

Personal Information: (Required fields are underlined)

What is your role?:
First Name:
Last Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Phone:
E-mail:
Emergency Contact:
Date Of Birth:
Gender:	Male Female
Credit Card Type:	Visa MasterCard AMEX Discover
Card #:
Expiration:

Racing Information: (Required fields are underlined)

License Number:
Team Name:
Please Select your ACA Classification:	Class A Class B Class C

Lodging:

for days.
Click on the links below to see additional information on the hotel choices:

Banquet:

Total cost for the selected items:
(Note: Total cost includes $65 registration fee, lodging costs, & banquet costs)