Please print as many copies as needed. 
Any checks must be mailed 15 days prior to each event 
NO CHECKS ACCEPTED AT POST REGISTION. 
                        Pre-Registration Entry Form 
20" License #:___________________ Bike #:__________________ Exp.date:______
Cruiser Lic #:___________________ Bike #:__________________ Exp.date:______ 
Age Day of Race:_________________ Date of Birth:___________________________ 
Name_______________________________________________________________________ 
Address____________________________________________________________________ 
City_________________________________________State______________Zip________ 
Phone( )______________________ 
State Qualifier Pre-Registration: 
   SATURDAY                         PRE               SUNDAY                          PRE 
   __Rookie                         $25.              __Rookie                        $25.
   __Novice                         $25.              __Novice                        $25. 
   __Expert                         $25.              __Expert                        $25. 
   __Cruiser                        $25.              __Cruiser                       $25.
   __Girls                          $25.              __Girls                         $25.
   __Girl Cruiser                   $25.              __Girl Cruiser                  $25. 
   __A-Pro                          $50.              __A-Pro                         $50. 
   __16 & Over Money Dash           $5.               __16 & Over Money Dash          $5. 
   __18 & Over Cruiser Money Dash   $5.               __18 & Over Cruiser Money Dash  $5. 

__I am registering 3 or more family members and entitled to the 
FAMILY DISCOUNT and deducting $5off each class entry for PRE-REGISTRATION ONLY.  No 
discounts will apply to post registration. 

__Season Fee $250.(9 State Qualifiers & Championship. NO REFUND. 
Non-Participating Does not qualify for 100%. Pay prior to the Mesquite Qualifier) 

Please print extra copies of this form if you are registering additional riders. 
REMEMBER TO SEND A COPY OF YOUR NBL LICENSE. 
Pre-Registration MUST BE POSTMARKED 15 DAYS PRIOR TO EVENT. 
Please send personal check or money order, payable to: 
Silver State BMX 1201 S. Jones suite #100, Las Vegas, NV. 89146 c/o Debi Diaz 

Date_____________________Amount Sent:_______________________