Français
Online Registration - Step 1 of 3
 
  
 
1. Identification (* = required)
First Name:*
Last Name:*
Gender:*
Address:*
Number  Street  Apt.
   
City:*
Province/State:*  or if other 
Country:*
Postal/ZIP code:*
Phone:* ( ) -
Fax: ( ) -
E-mail:*
Note: You must enter a valid email address in order to register and make your payment.
Age:*
Date of birth:* / /
 
2. Categories *
 
3. License number (Racers from outside Canada or the United-States must have an International License)
License Number:
(Please leave the field empty if you do not yet have a license number)
 
UCI ID (if known)
 
Purchase a license:
Conditions 		**Racers from Canada or the United-States only:
http://www.coupedesameriques.com/site2008/pdf/license_en.pdf.

 
4. Payment Method
  (Making a payment by credit card or by cheque will require that you fax, phone or mail in your credit card number or cheque.)
 
 
5. Registration Fees
Regular fee (until June 27, 2008) Late fee (after June 27, 2008)
$115 CAD / $115 USD $135 CAD / $135 USD
 
Select your currency to get the total amount*
Total Amount: $  
 
 
6. Risk Acknowledgment
I, the undersigned, recognize that participating in a race comprises inherent risks and dangers that may lead to accidents resulting in damages and injuries. I declare that I am familiar with the extent of these risks and dangers and that I accept them freely and voluntarily. I declare that I am familiar with the safety regulations of the Fédération québécoise des sports cyclistes and participation rules of the Coupe des Amériques and that I will abide by them. The registration will not be accepted without full payment and a valid signature of this release.
I have read, understood and accept the Risk Acknowledgment