Mail to: COBRA
3501 Truman Ave.
Bakersfield, CA 93309 Email COBRAps@aol.com
NO APPLICATIONS WILL BE ACCEPTED WITHOUT PAYMENT.
MEMBER INFORMATION - PLEASE PRINT
Check one:
___ New member;
___ Renewing; please give COBRA number ____________________
Name: Last ___________________First _________________ Birth Date(mm/dd/yr)_______________
Racing Age (as of 12/31/99):_______________
E-Mail Address _____________________________________________
Mailing Address ____________________________________________
City ___________________________ State ______ Zip ___________
Day Phone (_____) _______________ Eve. Phone (_____) _______________
Sex: Male ___ Female ___ Race Team or Club, _______________________________
NORBA Number, if any _________________________
NORBA Rider Categories
Cross
Country Downhill
Beginner ____ ____
Sport ____ ____
Expert ____ ____
Semi-Pro / Pro ____ ____
Signature _____________________________________________________
COBRA Membership (Paid once per year): $5.00
Fee is for the current 1999 race season (3/13/99 - 12/31/99) only.
COBRA will award Jerseys to the top 3 winners of each Class/Category in December 1999. Only those classes containing appropriate number of members will qualify. If you move up a Class you will still accumulate points in your original class.