Competition License Application This application is intended for those with prior racing experience who are new to RMVR and plan on racing regularly with us as a member. If you plan on gaining your Competition License by attending the RMVR Spring Drivers’ School, please use the Drivers’ School Packet rather than this application. Guests with a valid competition license from other VMC clubs need not apply for an RMVR license. The license from your home VMC club will suffice. Simply provide your current competition license info when you enter our event. Current RMVR members with a valid competition license need not re-apply—your license will be re-issued when you renew your membership and submit a current medical. Name* First Last Date of Birth* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email Address* Enter Email Confirm Email Home PhoneOffice PhoneCell PhoneAre you currently an RMVR member in good standing?*YesNoIn addition to this form, please submit an Application for Membership.Have you ever had an RMVR Competition License?*YesNoIn what year did your license expire?*20152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990For how many years did you have your previous license?*12345678910111213141516171819202122232425What was your license number?*Have you ever had a valid Competition License from another racing organization?*YesNoFrom what club?*License number?*Expiration Date?* Has your Competition License ever been revoked or suspended?*YesNoDate revoked or suspended?* Why was your license revoked or suspended?*Do you have a current racing medical exam?*Yes, on file with RMVRYes, with another organizationNoYou will need to provide a completed Medical Form in support of your application for a Competition License. Please mail to the RMVR administrator at: Rocky Mountain Vintage Racing, 1376 Columbine Drive Franktown, CO 80116When does your medical expire?* Please provide a scanned copy of your current racing medical exam:You can also mail a copy of your current exam to the RMVR administrator at: Rocky Mountain Vintage Racing, 1376 Columbine Drive, Franktown, CO 80116Please list any Racing Schools you have attended (with dates):*Please list all racing experience, including club racing, and types of cars raced:*When was your last race or competition?