2024 ECA Dublin World Cup Block

Application deadline for 2024 ECA Dublin World Cup Block: 8 Novembet 2024 (by 15:00 mountain).

Full Name (as it appears on your passport):

Passport # and Expiration Date:

Email Address:

Cell Number:

CX Racing Age (2024-25)

Date of Birth (day/month/year) E.g. 29 April 2004

UCI ID (11 digit number on your federation/license page/account):

Federation License #: (copy)

I 1) hold a valid passport (whose expiration date is AFTER March 1, 2025); 2) am in good standing with my federation; 3) am in good standing with the my federation's Center for SafeSport; 4) am in good standing with the UCI; 5) am in good standing with my federation's Anti-Doping Agency; 6) carry 2024 international health insurance. Please confirm/comment:

2024-25 Official Cx Team Name: (note: for all youth world cups, you will wear the jersey of your federation):

Hometown, State/Province, Country:

Parent 1 Name; Email Address; Phone Number

Parent 2 Name; Email Address; Phone Number

Coach/Trainer Name:

Coach/Trainer Email Address: