2008/9 CUEVAS/ACT JUNIOR DEVELOPMENT PROGRAM MEMBERSHIP FORM: Please fill out this form completely. Name:_________________________Racing Age (as of 12/31)_____ Lic No:_________ HomeAddress:____________________________________________Category________ City:__________________State:_______________________ Zip code:______________ Home Phone:__________________Cell Phone:________________ Email:___________ College/School Address:____________________________________________________ City:____________________________State:______________Zip code:_____________ College/School Phone:____________________School E-mail:_____________________ Additional Information which will help CUEVAS support its membership: Father:________________ Work Phone:_________________ Mother:_______________ Work Phone:_________________ MEMBERSHIP BENEFITS: 1. As a Not for Profit agency, all Membership dues are tax deductible. 2. Discounts on all of your cycling needs from Cuevas America's Cycling Team. 3. Unsurpassed support for and commitment to its members, via Coaching and Mentoring. 4. Team T-shirt 5. Team Stickers MEMBERSHIP FEE: CUEVAS America's Cycling Team annual membership (including Jersey and Bibs): $200 CUEVAS team bib-shorts and s/s jersey: $99 CUEVAS bibs: $60 CUEVAS jersey s/s: $60 CUEVAS jacket: $99 CUEVAS skinsuit: $125 Make check payable to America's Cycling Team/ CUEVAS and mail to:   Mike Fraysse Sports, LLC. 573 High Road PO Box 329 Glen Spey, NY 12737-0329

CUEVAS DEVELOPMENT * 192 Pleasant Street * Littleton * NH * 03561