2012 Bell's Beer Iceman Cometh Challenge

Saturday November 3, 2012

Entry Form
First name:________________ Last Name:________________________
Address:____________________________________________________
City:___________________________ State:_______ Zip Code:_______
Phone:________________________ Sex:

Male

Female

Email:____________________________ USAC License #____________

Birth Date:____________________ Age as of 12/31/2012:___________
Team:_____________________________________________________
Past results for seeding:________________ Year:________________

Circle one:
Iceman Pro & Category 1 ($78.00)
Iceman Age based category ($78.00)
Iceman Tandems ($78.00)
(Stoker's First Name:________________ Last Name:_______________________)
Iceman Single Speed ($78.00)
Iceman Clydesdales ($78.00)
Iceman MYC Junior categories (18 and under) ($48.00)
Meijer Slush Cup (8 mile race) ($48.00)

Return to:
Iceman Promotions, Inc. P.O. Box 3127 Traverse City, MI 49685