/ Union Cycliste Internationale
Sports Department / Track
E-mail:

Registration form for a UCI Track Team – 2018-2019

EXACT NAME OF THE TRACK TEAM

Preferred abbreviation (3 letters)
If possible, the choice will be respected as long as the abbreviation has not already been used in the past

For reasons of readability, all information on the form must be TYPED.

I. ADMINISTRATION & CONTACT
National Federation responsible for the Track Team
Name of the person
in charge of the file
Address at which all information for the team can be send
Complete name
Street
City + Zip Code
Phone
Fax
Email
Web site
Language of correspondence /  ENGLISH  FRENCH
First Main Sponsor (as per UCI regulations)
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Email
Web site
Second Main Sponsor (if applicable)
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Email
Web site
II. STAFF
Representative of the team (employer)
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Mobile Phone
Email
Team Manager(as per UCI regulations)
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Mobile Phone
Email
Assistant Team Manager(if applicable)
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Mobile Phone
Email
If applicable, name and address of another person
Job Title
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Mobile Phone
Email
II bis. ADDITIONAL STAFF - page to be duplicated as often as needed
If applicable, name and address of another person
Job Title
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Mobile Phone
Email
If applicable, name and address of another person
Job Title
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Mobile Phone
Email
If applicable, name and address of another person
Job Title
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Mobile Phone
Email
If applicable, name and address of another person
Job Title
Surname, name (Mr., Ms.)
Street
City + Zip Code
Phone
Mobile Phone
Email

III. RIDERS - (minimum 3, maximum 10) - page to be duplicated as often as needed

IMPORTANT: A rider belonging to a team registered with the UCI may not carry out another role.

Personal details of the rider and address of official residence
FAMILY NAME
First name
Date of birth (dd/mm/yyyy)
UCI ID (11 digits)
Nationality (see article 1.1.033)
Category / MEN WOMEN ELITE U23 JUNIORS
Street
City + Zip Code
Country
Phone
Email
Federation issuing the license
Contract Duration / From To
Annual salary (if paid rider) / Paid rider Annual salary:
Unpaid rider
Personal details of the rider and address of official residence
FAMILY NAME
First name
Date of birth (dd/mm/yyyy)
UCI ID (11 digits)
Nationality (see article 1.1.033)
Category / MEN WOMEN ELITE U23 JUNIORS
Street
City + Zip Code
Country
Phone
Email
Federation issuing the license
Contract Duration / From To
Annual salary (if paid rider) / Paid rider Annual salary:
Unpaid rider

III. RIDERS - (minimum 3, maximum 10) - page to be duplicated as often as needed

IMPORTANT: A rider belonging to a team registered with the UCI may not carry out another role.

Personal details of the rider and address of official residence
FAMILY NAME
First name
Date of birth (dd/mm/yyyy)
UCI ID (11 digits)
Nationality (see article 1.1.033)
Category / MEN WOMEN ELITE U23 JUNIORS
Street
City + Zip Code
Country
Phone
Email
Federation issuing the license
Contract Duration / From To
Annual salary (if paid rider) / Paid rider Annual salary:
Unpaid rider
Personal details of the rider and address of official residence
FAMILY NAME
First name
Date of birth (dd/mm/yyyy)
UCI ID (11 digits)
Nationality (see article 1.1.033)
Category / MEN WOMEN ELITE U23 JUNIORS
Street
City + Zip Code
Country
Phone
Email
Federation issuing the license
Contract Duration / From To
Annual salary (if paid rider) / Paid rider Annual salary:
Unpaid rider

IV. VERIFICATION AND CONFORMITY STATEMENT

Address of the National Federation and contact details of the person in charge of the file
FAMILY NAME
First name
Street
City + Zip Code
Country
Phone
Email
Website
Language of correspondence /  ENGLISH  FRENCH
In order to be accepted by the UCI, the mentions hereunder must appear. Moreover, each page of the form must be initialed by the President of the National Federation
1. Date
2. Stamp of the Federation
3. Signature of the President of the Federation preceded by the handwritten mention «verified and deemed in conformity with the applicable provisions»

The form must be returned to the UCI by email (signed scanned copy) with the following enclosures to enable the registration of the team:

-Riders’ contracts in English or in French (signed scanned copy)

-Jersey’s layout (jpg)

-and confirmation of payment.

Initialed by the President of the NF: ______Page 1