2026 NOVEMBER 15-16 EURO BLOCK APPLICATION FORM

Full Name (as it appears on your passport):

Passport # and Expiration Date:

Email Address:

Cell Number:

CX Racing Age (2026-27)

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

Federation License #:

UCI International License #: (you carry a UCI international license purchased through USAC):

I 1) hold a valid passport (whose expiration date is AFTER March 1, 2027); 2) am in good standing with my federation; 3) am in good standing with the my federation's Center for SafeSport (SS (all athletes who are 18+ at the time of camp must complete SS training course); 4) am in good standing with the UCI; 5) am in good standing with my federation's Anti-Doping Agency; 6) carry 2026-27 international health insurance. Please confirm/comment:

2026-27 Official Cx Team Name: (note: in Europe, you will be racing for ECA/in ECA kit):

Mailling address: include Street, Hometown, State/Province, Zip Code, Country:

ECA (Verge) Clothing:

Please list your sizing and specify Men's or Women's: 1) Long sleeve Jersey 2) Skinsuit/Speedsuit 3) Bib Shorts 4) Thermal Jacket 5) Leg Warmers 6) Cx Pants 7) Aero Socks 8) Vest 9) Sweatshirt/Hoodie (Unisex) 10) Parka (Unisex) 11) Shoe Size

Parent 1 Name; Email Address; Phone Number

Parent 2 Name; Email Address; Phone Number

Coach/Trainer Name:

Coach/Trainer Email Address: